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

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

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

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

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

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

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

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

Complex strategy Simple strategy p Age Men (%) Diabetics (%) EF (%) Bifurcation LCA (%) Basic data

Complex strategy Simple strategy p Direct stenting MB (%) PCI SB (%) < 0.01 Final kissing balloon-PCI (%) < 0.01 Crossover A B (%) Final TIMI III SB (%) Procedural charakteristics

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

Complex strategy Simple strategy p Re-PCI MB (%) (Re)-PCI SB (%) Stent thrombosis (%) CABG related to lesion (%) TLR (sum, %) PCI target vessel, non target lesion (%) TVR (sum, %) Cardiac death (%) ALL MACE (%) Follow-up 6 months

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

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

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

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