TY - JOUR
T1 - Randomized study of the crush technique versus provisional side-branch stenting in true coronary bifurcations
T2 - The CACTUS (Coronary bifurcations: Application of the Crushing Technique Using Sirolimus-eluting stents) study
AU - Colombo, Antonio
AU - Bramucci, Ezio
AU - Saccà, Salvatore
AU - Violini, Roberto
AU - Lettieri, Corrado
AU - Zanini, Roberto
AU - Sheiban, Imad
AU - Paloscia, Leonardo
AU - Grube, Eberhard
AU - Schofer, Joachim
AU - Bolognese, Leonardo
AU - Orlandi, Mario
AU - Niccoli, Giampaolo
AU - Latib, Azeem
AU - Airoldi, Flavio
PY - 2009/1/13
Y1 - 2009/1/13
N2 - Background-Sirolimus-eluting stents have been reported to be effective in the treatment of coronary bifurcations. Still, it has not been fully clarified which strategy would provide the best results with true bifurcation lesions. Methods and Results-The CACTUS trial (Coronary bifurcations: Application of the Crushing Technique Using Sirolimus-eluting stents) is a prospective, randomized, multicenter study comparing 2 different techniques of stenting, with mandatory final kissing-balloon inflation, in true bifurcations: (1) elective "crush" stenting and (2) stenting of only the main branch, with provisional side-branch T-stenting. From August 2004 to June 2007, 350 patients were enrolled in 12 European centers. The primary angiographic end point was the in-segment restenosis rate, and the primary clinical end point was the occurrence of major adverse cardiac events (cardiac death, myocardial infarction, or target-vessel revascularization) at 6 months. At 6 months, angiographic restenosis rates were not different between the crush group (4.6% and 13.2% in the main branch and side branch, respectively) and the provisional stenting group (6.7% and 14.7% in the main branch and side branch, respectively; P=NS). Additional stenting on the side branch in the provisional stenting group was required in 31% of lesions. Rates of major adverse cardiac events were also similar in the 2 groups (15.8% in the crush group versus 15% in the provisional stenting group, P=NS). Conclusions-In most bifurcations with a significant stenosis in both branches, a provisional strategy of stenting the main branch only is effective, with the need to implant a second stent on the side branch occurring in approximately one third of cases. The implantation of 2 stents does not appear to be associated with a higher incidence of adverse events at 6 months.
AB - Background-Sirolimus-eluting stents have been reported to be effective in the treatment of coronary bifurcations. Still, it has not been fully clarified which strategy would provide the best results with true bifurcation lesions. Methods and Results-The CACTUS trial (Coronary bifurcations: Application of the Crushing Technique Using Sirolimus-eluting stents) is a prospective, randomized, multicenter study comparing 2 different techniques of stenting, with mandatory final kissing-balloon inflation, in true bifurcations: (1) elective "crush" stenting and (2) stenting of only the main branch, with provisional side-branch T-stenting. From August 2004 to June 2007, 350 patients were enrolled in 12 European centers. The primary angiographic end point was the in-segment restenosis rate, and the primary clinical end point was the occurrence of major adverse cardiac events (cardiac death, myocardial infarction, or target-vessel revascularization) at 6 months. At 6 months, angiographic restenosis rates were not different between the crush group (4.6% and 13.2% in the main branch and side branch, respectively) and the provisional stenting group (6.7% and 14.7% in the main branch and side branch, respectively; P=NS). Additional stenting on the side branch in the provisional stenting group was required in 31% of lesions. Rates of major adverse cardiac events were also similar in the 2 groups (15.8% in the crush group versus 15% in the provisional stenting group, P=NS). Conclusions-In most bifurcations with a significant stenosis in both branches, a provisional strategy of stenting the main branch only is effective, with the need to implant a second stent on the side branch occurring in approximately one third of cases. The implantation of 2 stents does not appear to be associated with a higher incidence of adverse events at 6 months.
KW - Angioplasty
KW - Drug-eluting stents
KW - Follow-up studies
KW - Restenosis
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U2 - 10.1161/CIRCULATIONAHA.108.808402
DO - 10.1161/CIRCULATIONAHA.108.808402
M3 - Article
C2 - 19103990
AN - SCOPUS:59049093042
SN - 0009-7322
VL - 119
SP - 71
EP - 78
JO - Circulation
JF - Circulation
IS - 1
ER -