2. Treatment of bifurcation lesions is a complex problem Different techniques are commonly used (Y-/T-stenting, „culotte“ technique, „kissing stent“ technique…) Long-time data are sparse Introduction

3. P= ns Colombo et al, Circulation 2004 Bifurcations: stenting the side branch ?

4. Stenting of the MB with protection of the side branch with a 2. wire keeps the SB open in 91 % Terkamp et al, ZFK 2002 Bifurcations: protection of the SB using an inserted 2. wire

5. Stenting of the main branch after covering the side branch using a flow guided concept to treat the side branch (PCI only in case of TIMI flow 0 or 1) is not inferior to a scheduled final kissing balloon PCI with provisional stenting for the SB Study hypothesis

6. Primary endpoint: –TLR Secondary endpoints: –Restenosis > 50 % –TVR MACE: –Death –Myocardial infarction –Stent thrombosis –CABG Study design I: pre-defined endpoints

7. 110 patients enrolled (September 2004 – December 2006) PES stents were used (Taxus Liberte) Mean FU-duration: 6.1 months Study design II

8. Inclusion criteria Stable Angina/silent ischemia De-novo true bifurcation lesions (vessel size > 2.25 mm in both branches) Exclusion criteria NSTEMI/STEMI, cardiogenic shock Stenosis of the LM Restenosis/CTO Inclusion/Exclusion criteria

9. 110 consecutive pts with bifurcations - Stenting MB (PES) - „Kissing balloon“-PCI - Provisional stenting SB Group A - Stenting MB (PES) -PCI SB only @ TIMI 0 or 1 Group B (n=54) Scheduled angio @ 6 months (n=56) „Complex strategy“„Simple strategy“ Study design: flow chart

10. Complex strategy Simple strategy p Age66.865.10.4 Men (%)71.477.80.5 Diabetics (%)2525.90.9 EF (%)62.460.10.2 Bifurcation LCA (%) 80.481.50.9 Basic data

11. Complex strategy Simple strategy p Direct stenting MB (%) 53.675.90.01 PCI SB (%)82.116.7< 0.01 Final kissing balloon-PCI (%) 73.213.0< 0.01 Crossover A B (%) 17.916.70.9 Final TIMI III SB (%) 94.688.90.3 Procedural charakteristics

12. Complex strategy Simple strategy p Final TIMI III MB (%) 100 1 Duration X-ray (min) 14.27.8< 0,01 Contrast medium (ml) 209152< 0,01 Troponin I after PCI (24 h) 42,40,6 Procedural charakteristics II

13. Complex strategy Simple strategy p Re-PCI MB (%)5.45.61.0 (Re)-PCI SB (%)5.400.09 Stent thrombosis (%)3.63.71.0 CABG related to lesion (%) 3.65.60.6 TLR (sum, %)17.914.80.7 PCI target vessel, non target lesion (%) 5.45.61.0 TVR (sum, %)23.220.40.7 Cardiac death (%)03.70.2 ALL MACE (%)23.224.10.9 Follow-up data @ 6 months

14. Complex strategy Simple strategy p Binary restenosis MB (%) 10.75.60.32 Late lumen loss MB (mm) 0.240.290.5 Follow-up data: QCA (In- Segment)

15. A simple strategy using PES with only provisional SB-PCI according to the TIMI flow of the SB is not inferior to a more complex strategy with mandatory SB-PCI Conclusions I: treatment of bifurcation lesions

16. MACE rates are nearly identical for both strategies Comparing the duration of radioscopy + the amount of contrast medium benefits were revealed for the simple strategy The more simpler strategy may be the more better strategy… Conclusions II: treatment of bifurcation lesions

17. Thank you very much for your attention