Skip to main content
SpringerLink
Log in

DK mini-culotte stenting in the treatment of true coronary bifurcation lesions: a propensity score matching comparison with T-provisional stenting

  • Original Article
  • Published:
Heart and Vessels Aims and scope Submit manuscript

Abstract

The conventional culotte technique remains not to be widely used for the treatment of coronary bifurcation lesions due to its inherent drawbacks. Here, we developed a double kissing mini-culotte stenting (DK mini-culotte) and assessed its efficacy and safety by a propensity score matching comparison (PSM) with T-provisional stenting. From June 2010 to June 2012, a total of 223 consecutive patients with true coronary bifurcation lesions (TCBLs) were treated with DK mini-culotte (91 patients with 92 lesions) or T-provisional stenting (132 patients with 135 lesions). We performed a PSM to correct the confounders from clinical and lesion’s characteristics. The primary endpoint was cumulative major adverse cardiac event (MACE) at 1 year including cardiac death, myocardial infarction, and target vessel revascularization or target lesion revascularization (TVR/TLR). The secondary endpoint was the rate of side branch (SB) restenosis at 12 months. After a PSM, there were 66 patients in each group. Additional SB stenting in the T-provisional group was performed in 10 (15.2 %) lesions. The incidence of 1-year cumulative MACE was 4.55 % for the DK mini-culotte versus 13.6 % for T-provisional stenting (P = 0.127), the rate of TVR/TLR was 1.52 % for DK mini-culotte versus 12.12 % for T-provisional stenting (P = 0.033). The SB binary restenosis rate was 5.6 % in the DK mini-culotte group and 22.4 % in the T-provisional group (P = 0.014). In summary, despite that there is no difference in MACE between groups, DK mini-culotte significantly reduce TVR/TLR and SB restenosis in the treatment of true coronary bifurcation lesions.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Behan MW, Holm NR, Curzen NP, Erglis A, Stables RH, de Belder AJ, Niemelä M, Cooter N, Chew DP, Steigen TK, Oldroyd KG, Jensen JS, Lassen JF, Thuesen L, Hildick-Smith D (2011) Simple or complex stenting for bifurcation coronary lesions: a patient-level pooled-analysis of the Nordic Bifurcation Study and the British Bifurcation Coronary Study. Circ Cardiovasc Interv 4:57–64

    Article  PubMed  Google Scholar 

  2. Stankovic G, Lefèvre T, Chieffo A, Hildick-Smith D, Lassen JF, Pan M, Darremont O, Albiero R, Ferenc M, Finet G, Adriaenssens T, Koo BK, Burzotta F, Louvard Y, European Bifurcation Club (2013) Consensus from the 7th European Bifurcation Club meeting. Eurointervention 9:36–45

    Article  PubMed  Google Scholar 

  3. Grundeken MJ, Stella PR, Wykrzykowska JJ (2012) Why the provisional single-stent approach is not always the right strategy; arguments for the development of dedicated bifurcation devices. Eurointervention 7:1249–1253

    Article  PubMed  Google Scholar 

  4. Moussa ID (2011) Coronary artery bifurcation interventions: the disconnect between randomized clinical trials and patient centered decision-making. Catheter Cardiovasc Interv 77:537–545

    Article  PubMed  Google Scholar 

  5. Lee MS, Finch W (2011) Stenting techniques for patients with bifurcation coronary artery disease. Rev Cardiovasc Med 12:231–239

    PubMed  Google Scholar 

  6. Chen SL, Ye F, Zhang JJ, Zhu ZS, Lin S, Shan SJ, Liu ZZ, Liu Y, Duan BX, Ge JB (2005) DK crush technique: modified treatment of bifurcation lesions in coronary artery. Chin Med J 118:1746–1750

    PubMed  Google Scholar 

  7. Chen LL, Fan L, Chen ZY, Zhen XC, Luo YK, Lin CG, Peng YF (2011) Modified culotte stenting for treatment of complex coronary bifurcation lesions: immediate and 9-month outcomes in a pilot study. Chin Med J 124:1943–1950

    PubMed  Google Scholar 

  8. Isaaz K, Bayle S, Lamaud M, Robin C, Cerisier A, Mayaud N, Richard L, Sabry MH, Khamis H, Abd-Alaziz A, Da Costa A (2013) Immediate and long-term results of a modified simultaneous kissing stenting for percutaneous coronary intervention of coronary artery bifurcation lesions. J Invasive Cardiol 25:126–131

    PubMed  Google Scholar 

  9. Chevalier B, Glatt B, Royer T, Guyon P (1998) Placement of coronary stents in bifurcation lesions by the “culotte” technique. Am J Cardiol 82:943–949

    Article  CAS  PubMed  Google Scholar 

  10. Kaplan S, Barlis P, Dimopoulos K, La Manna A, Goktekin O, Galassi A, Tanigawa J, Di Mario C (2007) Culotte versus T-stenting in bifurcation lesions: immediate clinical and angiographic results and midterm clinical follow-up. Am Heart J 154:336–343

    Article  PubMed  Google Scholar 

  11. Hoye A, van Mieghem CA, Ong AT, Aoki J, Rodriguez Granillo GA, Valgimigli M, Tsuchida K, Sianos G, McFadden EP, van der Giessen WJ, de Feyter PJ, van DoMVurg RT, Serruys PW (2005) Percutaneous therapy of bifurcation lesions with drug-eluting stent implantation: the culotte technique revisited. Int J Cardiovasc Intervent 7:36–40

    Article  PubMed  Google Scholar 

  12. Adriaenssens T, Byrne RA, Dibra A, Iijima R, Mehilli J, Bruskina O, Schömig A, Kastrati A (2008) Culotte stenting technique in coronary bifurcation disease: angiographic follow-up using dedicated quantitative coronary angiographic analysis and 12-month clinical outcomes. Eur Heart J 29:2868–2876

    Article  PubMed  Google Scholar 

  13. Erglis A, Kumsars I, Niemelä M, Kervinen K, Maeng M, Lassen JF, Gunnes P, Stavnes S, Jensen JS, Galløe A, Narbute I, Sondore D, Mäkikallio T, Ylitalo K, Christiansen EH, Ravkilde J, Steigen TK, Mannsverk J, Thayssen P, Hansen KN, Syvänne M, Helqvist S, Kjell N, Wiseth R, Aarøe J, Puhakka M, Thuesen L, Nordic PCI Study Group (2009) Randomized comparison of coronary bifurcation stenting with the crush versus the culotte technique using sirolimus eluting stents: the Nordic stent technique study. Circ Cardiovasc Interv 2:27–34

    Article  PubMed  Google Scholar 

  14. Lefevre T, Louvard Y, Morice MC, Dumas P, Loubeyre C, Benslimane A, Premchand RK, Guillard N, Piéchaud JF (2000) Stenting of bifurcation lesions: classification, treatments, and results. Catheter Cardiovasc Interv 49:274–283

    Article  CAS  PubMed  Google Scholar 

  15. Medina A, Suarez de Lezo J, Pan M (2006) A new classification of coronary bifurcation lesions. Rev EspCardiol 59:183

    Google Scholar 

  16. Brunel P, Lefevre T, Darremont O, Louvard Y (2006) Provisional T-stenting and kissing balloon in the treatment of coronary bifurcation lesions: results of the French multicenter “TULIPE” study. Catheter Cardiovasc Interv 68:67–73

    Article  PubMed  Google Scholar 

  17. Levine GN, Bates ER, Blankenship JC, Bailey SR, Bittl JA, Cercek B, Chambers CE, Ellis SG, Guyton RA, Hollenberg SM, Khot UN, Lange RA, Mauri L, Mehran R, Moussa ID, Mukherjee D, Nallamothu BK, Ting HH (2011) 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions. Circulation 124:e574–e651

    Article  PubMed  Google Scholar 

  18. Cutlip DE, Windecker S, Mehran R, Boam A, Cohen DJ, van Es GA, Steg PG, Morel MA, Mauri L, Vranckx P, McFadden E, Lansky A, Hamon M, Krucoff MW, Serruys PW, Academic Research Consortium (2007) Clinical end points in coronary stent trials: a case for standardized definitions. Circulation 115:2344–2351

    Article  PubMed  Google Scholar 

  19. Galassi AR, Colombo A, Buchbinder M, Grasso C, Tomasello SD, Ussia GP, Tamburino C (2007) Long-term outcomes of bifurcation lesions after implantation of drug-eluting stents with the “mini-crush technique”. Catheter Cardiovasc Interv 69:976–983

    Article  PubMed  Google Scholar 

  20. Kervinen K, Niemelä M, Romppanen H, Erglis A, Kumsars I, Maeng M, Holm NR, Lassen JF, Gunnes P, Stavnes S, Jensen JS, Galløe A, Narbute I, Sondore D, Christiansen EH, Ravkilde J, Steigen TK, Mannsverk J, Thayssen P, Hansen KN, Helqvist S, Vikman S, Wiseth R, Aarøe J, Jokelainen J, Thuesen L, Nordic PCI Study Group (2013) Clinical outcome after crush versus culotte stenting of coronary artery bifurcation lesions: the Nordic Stent Technique Study 36-month follow-up results. JACC Cardiovasc Interv 6:1160–1165

    Article  PubMed  Google Scholar 

  21. Murasato Y, Hikichi Y, Horiuchi M (2009) Examination of stent deformation and gap formation after complex stenting of left main coronary artery bifurcations using microfocus computed tomography. J Interv Cardiol 22:135–144

    Article  PubMed  Google Scholar 

  22. Foin N, Alegria-Barrero E, Torii R, Chan PH, Viceconte N, Davies JE, Di Mario C (2013) Crush, culotte, T and protrusion: which 2-stent technique for treatment of true bifurcation lesions? Insights from in vitro experiments and micro-computed tomography. Circ J 77:73–80

    Article  PubMed  Google Scholar 

  23. Kawasaki T, Koga H, Serikawa T (2010) Modified culotte stenting technique for bifurcation lesions: the cross-stenting technique. J Invasive Cardiol 22:243–246

    PubMed  Google Scholar 

  24. Chen SL, Xu B, Han YL, Sheiban I, Zhang JJ, Ye F, Kwan TW, Paiboon C, Zhou YJ, Lv SZ, Dangas GD, Xu YW, Wen SY, Hong L, Zhang RY, Wang HC, Jiang TM, Wang Y, Chen F, Yuan ZY, Li WM, Leon MB (2013) Comparison of double kissing crush versus Culotte stenting for unprotected distal left main bifurcation lesions: results from a multicenter, randomized, prospective DKCRUSH-III study. J Am Coll Cardiol 61:1482–1488

    Article  PubMed  Google Scholar 

  25. Maeng M, Holm NR, Erglis A, Kumsars I, Niemelä M, Kervinen K, Jensen JS, Galløe A, Steigen TK, Wiseth R, Narbute I, Gunnes P, Mannsverk J, Meyerdierks O, Rotevatn S, Nikus K, Vikman S, Ravkilde J, James S, Aarøe J, Ylitalo A, Helqvist S, Sjögren I, Thayssen P, Virtanen K, Puhakka M, Airaksinen J, Christiansen EH, Lassen JF, Thuesen L, Nordic-Baltic Percutaneous Coronary Intervention Study Group (2013) Long-term results after simple versus complex stenting of coronary artery bifurcation lesions: nordic bifurcation study 5-year follow-up results. J Am Coll Cardiol 62:30–34

    Article  PubMed  Google Scholar 

  26. Colombo A, Bramucci E, Saccà S, Violini R, Lettieri C, Zanini R, Sheiban I, Paloscia L, Grube E, Schofer J, Bolognese L, Orlandi M, Niccoli G, Latib A, Airoldi F (2009) Randomized study of the crush technique versus provisional side-branch stenting in true coronary bifurcations: the CACTUS (coronary bifurcations: application of the crushing technique using sirolimus-eluting stents) Study. Circulation 119(1):71–78

    Article  PubMed  Google Scholar 

  27. Koh YS, Kim PJ, Chang K, Park HJ, Jeong MH, Kim HS, Jang Y, Gwon HC, Park SJ, Seung KB (2013) Long-term clinical outcomes of the one-stent technique versus the two-stent technique for non-left main true coronary bifurcation disease in the era of drug-eluting stents. J Interv Cardiol 26:245–253

    Article  PubMed  Google Scholar 

  28. Zhang F, Dong L, Ge J (2009) Simple versus complex stenting strategy for coronary artery bifurcation lesions in the drug-eluting stent era: a meta-analysis of randomised trials. Heart 95:1676–1681

    Article  CAS  PubMed  Google Scholar 

  29. Jim MH, Wu EB, Fung RC, Ng AK, Yiu KH, Siu CW, Ho HH (2014) Angiographic result of T-stenting with small protrusion using drug-eluting stents in the management of ischemic side branch: the ARTEMIS study. Heart Vessels. doi:10.1007/s00380-014-0492-9

    Google Scholar 

  30. Costa RA, Mintz GS, Carlier SG, Lansky AJ, Moussa I, Fujii K, Takebayashi H, Yasuda T, Costa JR Jr, Tsuchiya Y, Jensen LO, Cristea E, Mehran R, Dangas GD, Iyer S, Collins M, Kreps EM, Colombo A, Stone GW, Leon MB, Moses JW (2005) Bifurcation coronary lesions treated with the “crush” technique: an intravascular ultrasound analysis. J Am Coll Cardiol 46:599–605

    Article  PubMed  Google Scholar 

  31. Biondi-Zoccai G, Sheiban I, De Servi S, Tamburino C, Sangiorgi G, Romagnoli E (2013) To kiss or not to kiss? Impact of final kissing-balloon inflation on early and long-term results of percutaneous coronary intervention for bifurcation lesions. Heart Vessels. doi:10.1007/s00380-013-0416-0

    Google Scholar 

  32. Niemelä M, Kervinen K, Erglis A, Holm NR, Maeng M, Christiansen EH, Kumsars I, Jegere S, Dombrovskis A, Gunnes P, Stavnes S, Steigen TK, Trovik T, Eskola M, Vikman S, Romppanen H, Mäkikallio T, Hansen KN, Thayssen P, Aberge L, Jensen LO, Hervold A, Airaksinen J, Pietilä M, Frobert O, Kellerth T, Ravkilde J, Aarøe J, Jensen JS, Helqvist S, Sjögren I, James S, Miettinen H, Lassen JF, Thuesen L, Nordic-Baltic PCI Study Group (2011) Randomized comparison of final kissing balloon dilatation versus no final kissing balloon dilatation in patients with coronary bifurcation lesions treated with main vessel stenting: the Nordic-Baltic Bifurcation Study III. Circulation 123(1):79–86

    Article  PubMed  Google Scholar 

  33. Galassi AR, Tomasello SD, Capodanno D, Barrano G, Ussia GP, Tamburino C (2009) Mini-crush versus T-provisional techniques in bifurcation lesions: clinical and angiographic long-term outcome after implantation of drug-eluting stents. JACC Cardiovasc Interv 2:185–194

    Article  PubMed  Google Scholar 

  34. Chen SL, Santoso T, Zhang JJ, Ye F, Xu YW, Fu Q, Kan J, Paiboon C, Zhou Y, Ding SQ, Kwan TW (2011) A randomized clinical study comparing double kissing crush with provisional stenting for treatment of coronary bifurcation lesions: results from the DKCRUSH-II (double kissing crush versus provisional stenting technique for treatment of coronary bifurcation lesions) trial. J Am Coll Cardiol 57:914–920

    Article  PubMed  Google Scholar 

  35. Kwan TW, Gujja K, Liou MC, Huang Y, Wong S, Coppola J, Chen SL (2013) Bifurcation stenting in patients with ST-segment elevation myocardial infarction: an analysis from dkcrush II randomized study. Catheter Cardiovasc Interv 82:E133–E137

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

This work was supported by a Grant from national natural science foundation of China (No. 81370311) and partially by Miaopu foundation of Fujian Medical University (No. 2010MP042).

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Department of Cardiology, Union Hospital, Fujian Medical University, Fujian, China

    Lin Fan, Lianglong Chen, Yukun Luo, Linlin Zhang, Wenliang Zhong, Chaogui Lin, Zhaoyang Chen, Yafei Peng, Xingchun Zhen & Xianfeng Dong

  2. Institute of Coronary Heart Disease, Fujian, China

    Lin Fan, Lianglong Chen, Yukun Luo, Linlin Zhang, Wenliang Zhong, Chaogui Lin, Zhaoyang Chen, Yafei Peng, Xingchun Zhen & Xianfeng Dong

  3. Xinquan Road 29, Fuzhou, 350001, China

    Lianglong Chen

Authors
  1. Lin Fan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Lianglong Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yukun Luo
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Linlin Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Wenliang Zhong
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Chaogui Lin
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Zhaoyang Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Yafei Peng
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Xingchun Zhen
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Xianfeng Dong
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Lianglong Chen.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOCX 2612 KB)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Fan, L., Chen, L., Luo, Y. et al. DK mini-culotte stenting in the treatment of true coronary bifurcation lesions: a propensity score matching comparison with T-provisional stenting. Heart Vessels 31, 308–321 (2016). https://doi.org/10.1007/s00380-014-0611-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00380-014-0611-7

Keywords

Search

Navigation