Optional Side Branch Stenting as Effective as Mandatory
Strategies were compared in de novo bifurcation lesions using sirolimus-eluting stents.
Stenting the main vessel and optionally stenting the side branch can be recommended as the routine bifurcation stenting technique, according to results from the Nordic Bifurcation trial.
At eight months follow-up, the rate of main vessel in-lesion stenosis with diameter greater than 50% was 5.3% with optional side branch stenting and 5.1% with mandatory side branch stenting.
“Independent of stenting strategy, the procedural success rates were high, the MACE rate low and the rate of angiographic stenosis low in both treatment groups,” said Andrejs Erglis, MD, of P. Stradins University Hospital in Latvia.
MLD and stenosis
Minimal lumen diameter was measured in the proximal and distal main vessel segments and in the side branch post-procedure and at eight months follow-up (see Figure 1).
Researchers also measured stenosis in the main vessel, the side branch, and the entire bifurcation lesion by angiography at eight months (see Figure 2).
Although post-procedure MLD was increased in all parts of the bifurcation in the side branch-stented group, this did not result in a lower rate of greater than 50% stenosis at follow-up.
Study design
The Nordic Bifurcation trial was conducted at 28 centers in five European countries. Researchers enrolled 413 patients who had a mean age of 65 years. Approximately 25% had a history of PCI.
Patients were randomized to one of two treatment groups: treatment of the main vessel with optional stenting of side branch or treatment of the main vessel with mandatory stenting of the side branch.
Side branch
The side branch was treated with angioplasty if TIMI flow was less than 3, and with stenting if TIMI was zero after balloon angioplasty.
The side branch was stented 2.7% of the time in the optional stenting group.
Inclusion criteria were typical of stent trials, Erglis said. However, he noted that the diameter of the main vessel had to exceed 2.5 mm by visual estimate.
