Circ: Simplify bifurcation stenting with no final kissing balloon dilatation

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It is not necessary to perform a final kissing balloon dilatation after stenting the main branch of a bifurcation lesion, which enables a reduction in contrast media, as well as shorter procedure and fluoroscopy times, based on study results in the Jan. 4/11 issue of Circulation.

Matti Niemelä, from the University of Oulu in Oulu, Finland, and colleagues from the Nordic-Baltic Bifurcation Study III randomized 477 patients to final kissing balloon dilatation (FKBD) or no FKBD after main vessel stenting in patients with bifurcation lesions.

The six-month major adverse cardiac event rates were not significantly different between the two groups. In addition, the proportion of reported angina was similar in the study groups before and six months after PCI.

At the eight-month angiographic follow-up, researchers found no significant difference in the binary restenosis rate of the entire bifurcation lesion (main branch plus side branch) in the two treatment arms. However, the rate of side branch restenosis was increased in the no-FKBD group, primarily as a result of increased restenosis in true bifurcation lesions (flow-limiting lesions in both the main and side branches) treated without FKBD.

In the first Nordic Bifurcation Trial, researchers found that the optimal strategy was to stent the main branch with provisional stenting of the side branch.

However, the question remained "whether the main branch stent should always be opened at the side branch ostium by side branch rewiring through the main branch stent and subsequent balloon dilatation. It might be expected that side branch blood flow would improve after opening the main branch stent at the side branch ostium," Niemelä and colleagues wrote.

However, there was concern that the main branch stent would deform upon opening, which can be corrected with FKBD.

Niemelä et al concluded that their results were similar in both arms and that this treatment seems "applicable to almost all bifurcation lesions with normal side branch blood flow after main branch stenting."

The study resulted in a comparable low rate of definite stent thrombosis in both groups (0.4 percent).

"Thus, main branch stenting without FKBD could be performed without increasing the risk of stent thrombosis within the observation period," the researchers said, adding that longer follow-up is needed to obtain a reliable assessment of the risk of stent thrombosis.