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Drug-eluting stent implantation in bifurcated lesions with balloon-crushing technique and 6 fr guiding catheter: immediate and mid-term results.

UNLABELLED
Bifurcated lesions are associated with higher complexity and restenosis. Sometimes implantation of two stents is necessary, requiring larger guiding catheters. We describe the implantation of two drug-eluting stents (DES) utilizing the balloon-crushing technique and 6 Fr catheters.


METHODS
This was a prospective and observational study of a cohort of 15 consecutive patients with 1 bifurcated lesion treated with 2 DES through a 6 Fr catheter and the balloon-crushing technique between April and November 2005. The baseline characteristics of the patients, lesions and procedures were registered. Clinical follow up was obtained by telephone contact.


RESULTS
Patient age ranged from 71.6+/- 9.4 years; 6 patients (40%) had diabetes; ejection fraction was 56 +/- 12%; radial access was used in 4 patients (26.6%). In 9 patients (60%) the target lesion was the left main artery; in 3 patients (20%) the target lesion was the LAD/diagonal and in the remaining 3 patients (20%), the target lesion was the circumflex/obtuse marginal. The median follow-up period was 316 days. There were 2 sudden deaths: 1 patient whose target lesion was the left main artery died 10 days following the procedure, and the other patient whose lesion was in the in LAD/diagonal died at day-187, 10 days following stent thrombosis. Both of them presented with severe ventricular dysfunction prior to the intervention. One patient required new percutaneous intervention due to in-segment restenosis in the left main artery. The composite major adverse cardiac events at follow up was 5 (33.3%, 2 deaths, 2 non-Q-wave myocardial infarctions and 1 revascularization).


CONCLUSIONS
This technique permits the treatment of bifurcated lesions with 2 stents using 6 Fr guiding catheters, which could be very useful in radial access procedures. However, though the angiographic results were very satisfactory, the events observed in the follow-up period require a word of caution about its mid-term safety.