TCT.14: DKCRUSH-IV shows simpler is better in side branch stenting

WASHINGTON, D.C. -- Fractional flow reserve (FFR)-guided side branch lesion stenting holds promise of fewer stents placed and more years between retreatment of stenosis, according to findings presented Sept. 14 at the Transcatheter Cardiovascular Therapeutics (TCT) conference.

The DKCRUSH-VI study presented by Shao-Liang Chen, MD, director of cardiology and cath lab at Nanjing First Hospital in China, compared FFR-guided stenting against an angiographic method at the late-breaking clinical trials press conference.

Chen, also a professor with Nanjing Medical University, found that the FFR method, while more technically difficult, resulted in fewer stents being placed and a lower long-term restenosis rate. Similar rates of major adverse cardiac events (MACE) were seen between the two groups.

Side branch treatment occurred in 56.3 percent of FFR cases vs 63.2 percent of angiography-guided cases. Fewer stents were attempted in the FFR group, but were largely as successful as those in the angiography-guided group (77.3 percent vs 83.6 percent).

“Given the nearly identical one-year MACE rates with both approaches, either the angiography-guided or FFR-guided technique may be recommended for provisional side branch stenting of true bifurcation lesions,” said Chen in a press release.

William F. Fearon, MD, discussant and associate professor at Stanford University Medical Center in California, found the results suggested an approach that doesn’t encroach on the side branch might be best. “The less we do to the side branch the better the patient does. Though there’s more residual stenosis at follow-up (after FFR-guided intervention), the main branch is what we’re concerned about with PCI. It appeared that the main branch had less restenosis in the FFR group."

He added, "The take home message that I think this study gives us and reiterates from other studies is that in bifurcation, simpler approach is better.”

The DKCRUSH-VI trial was funded by the Jiangsu Provincial Special Program of Medical Science.