CARDIOLOGY / RESEARCH PAPER
Comparison of Different Stenting Techniques of Coronary Bifurcation Lesions: A Network Meta-Analysis of 7601 Patients
 
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1
Soroka Medical Center, Ben-Gurion University of The Negev, Beer Sheva, Israel, Israel
2
Department of Cardiology, University Hospital of Brest, Brest, France, France
3
MedStar Washington Hospital Center, Washington DC, USA, United States
4
Soroka Medical Center, Ben-Gurion University of The Negev, Beer Sheva, Israel, Israel, Israel
CORRESPONDING AUTHOR
Edward Koifman   

Soroka Medical Center, Ben-Gurion University of The Negev, Beer Sheva, Israel, beer sheva, Israel
Submission date: 2020-11-29
Final revision date: 2021-01-21
Acceptance date: 2021-01-24
Online publication date: 2021-03-21
 
 
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ABSTRACT
Introduction:
Intervention on coronary bifurcations lesions (CBL) is challenging. While provisional side branch (PS) stenting is the recommended method in most cases, there is no consensus on the preferred 2-stent technique.

Material and methods:
We performed a network meta-analysis including randomized controlled trials (RCT) and observational studies comparing stenting techniques in CBL with reported clinical outcomes. A mixed treatment comparison model generation was performed to compare culotte, T and protrusion (TAP), crush and provisional techniques.

Results:
We included 14 RCT and 14 observational studies comprising 7,601 patients among whom 2,516 were treated with PS, 792 with TAP, 1,493 with culotte and 2,808 with crush. A Bayesian network meta-analysis showed a significant rate reduction of major adverse cardiovascular events (OR=0.73; 95%CI 0.52-0.99) and a trend for reduction in lesion revascularization (OR=0.72; 95%CI 0.48-1.11) and myocardial infarction (OR=0.62; 95%CI 0.3-1.08) with the crush technique, mainly driven by the double kissing (DK) crush, compared with all other stenting techniques. Other clinical outcomes, including mortality and stent thrombosis (ST) did not differ significantly between methods.

Conclusions:
The crush technique, and especially DKcrush, is associated with improved outcomes compared to culotte, T and protrusion (TAP) and provisional techniques for CBL treatment. Further research is required to determine the optimal stenting technique for CBL.

eISSN:1896-9151
ISSN:1734-1922