Aims: Target lesion revascularization (TLR) rates of bifurcated lesions (BL) remain high, mainly due to side branch (SB) restenosis, even when drug-eluting stents (DES) are used. The aim of our study was to evaluate long-term clinical outcomes of a stepwise approach with single bare metal R stent implantation for BL.
Methods and results: In 465 patients, PCI was performed using a double guide wire, single stent in main branch (MB), and angioplasty of the SB, aiming at an optimal angiographic result of the MB and an optimal functional result (TIMI 3 flow) of the SB. 105 patients were treated for a true bifurcated lesion (TBL) and 360 patients were treated for a lesion with involvement of a significant side branch (ISB). Procedural success was achieved in all TBL and in 99% of ISB. At 1 year clinical follow-up, 8.6% treated for TBL had clinically driven TLR, 7.6% underwent repeat PCI, 1.0% underwent CABG. For patients treated for ISB, 13% had clinically driven TLR, 9.4% underwent repeat PCI, 3.6% CABG. 4 patients treated for TBL suffered non-fatal MI vs. 20 patients treated for ISB. Cardiac death occurred in 1.9% and 2.5 % respectively.
Conclusion: A simple approach in the percutaneous treatment of BL using a single bare metal R stent results in good 1 year clinical outcome comparable to the outcome reported following DES implantation.