Main branch and side branch stenting vs provisional 1-branch stenting for bifurcating coronary lesions using the paclitaxel drug-eluting stent: a single-center experience with intermediate term follow-up

Background: Multiple strategies have been proposed to treat bifurcating coronary artery disease including both main branch (MB) stenting and side branch (SB) stenting (MBSB) or 1-branch stenting with provisional stenting of the other branch (PSOB). We present our own experience with MBSB stenting vs PSOB using the Taxus (Boston Scientific, Natick, MA) paclitaxel drug-eluting stent (Boston Scientific). The study was approved by the institutional review board at our center. Methods: Five hundred eighteen consecutive patients with de novo lesions underwent bifurcating stenting in 2005 at our institution using the Taxus stent (86 PSOB, 432 MBSB). Follow-up data on 312 (60.2%) patients was achieved using phone interviews and review of medical records (52 PSOB, 260 MBSB). Mean follow-up was 6.7 months. Plavix and aspirin were ordered for at least 6 months post procedure. The primary end point of the study was the combined end points of cardiac death, nonfatal myocardial infarction (ST-elevation MI and non–ST-elevation MI) and target lesion revascularization. Secondary outcomes included the individual end points of death, cardiac death, AST, TVR, target lesion revascularization, ST-elevation MI, and non–ST-elevation MI. Results: Demographic, clinical, and angiographic variables were not statistically different between the 2 groups. Procedural success (b30% residual) was 98% and 94% in the MB and SB in the MBSB group and 100% and 94.4% in the MB or SB, respectively, in the PSOB group. Kissing balloon was performed in 76% of lesions treated. Intermediate-term outcomes between MBSB and PSOB were statistically similar with a trend toward a better overall combined primary end point in the PSOB group compared to the MBSB one (10.8% vs 5.8% respectively). Conclusion: A strategy of PSOB provides similar intermediate-term outcomes to MBSB stenting and needs to be considered as a first approach to treating bifurcating disease.