3‐year follow‐up of 100 consecutive coronary bifurcation lesions treated with Taxus stents and the crush technique

Objectives : To determine the 3 year safety and efficacy of crush‐stenting with paclitaxel‐eluting stents. Background : The optimum two‐stent strategy for treatment of coronary bifurcation lesions is undetermined. Crush‐stenting is advocated to minimize restenosis through complete circumferential stent coverage; long‐term follow‐up data are lacking. Methods and Results : In a single center prospective registry, 100 consecutive patients with bifurcation lesions were treated with the Crush technique. The vast majority (93%) were true bifurcations, predominantly involving the left anterior descending and diagonal arteries. Technical success was 98%. Final kissing balloon dilatation, which became standard practice during the study, was attempted in 68 patients and successful in 51. Abciximab was used in all cases. There were no peri‐procedural stent thromboses. Follow‐up was 100% at 3 years. Symptom‐driven target lesion revascularisation was 8% at 3 years. Cumulative 3‐year major adverse cardiac events was 28% (7 cardiac deaths, 15 myocardial infarctions, 11 target vessel revascularisations). Absence of a final kissing inflation predicted repeat revascularisation but not death, infarction or stent thrombosis. Three probable stent thromboses occurred, of which two were very late. Conclusion : Where a two‐stent bifurcation strategy is required, Crush‐stenting with paclitaxel‐eluting stents is safe and effective in the long‐term. Failure to perform a final kissing dilatation increases the likelihood of revascularisation but not other adverse events. © 2009 Wiley‐Liss, Inc.