Predictors for Crossover from One Stent to 2 Stent Techniques While Treating Coronary Bifurcation Lesions

Background and Objectives: Based on multiple randomized studies and registries on one- vs. 2-stents techniques in coronary bifurcation, and based on the KISSS principle (Keep It Simple Swift and Safe), the accepted approach to bifurcation stenting is primarily a provisional stenting. Since planning is crucial for procedural success we aimed to investigate the predictors for crossover from one to 2-stents in the treatment of coronary bifurcation.

Methods: We analyzed 923 consecutive patients who underwent PCI involving a true bifurcation. The clinical, angiographic and procedural characteristics were analyzed and correlated to crossover from one to 2-stents.

Results: 38% of the patients presented with stable angina, 47% with acute coronary syndrome, 15% with ST-elevation myocardial infarction. 58% presented with acute angle (˂70°) bifurcation.

Table 1: Medina classification

One stent was planned in 644 patients(70%), crossover to 2-stents was observed in 83 patients (13%).

In a univariate analysis predictors for crossover were as follows: Medina 1,1,1 (p=0.004) and side branch predilatation (p=0.001). Multivariate analysis revealed that side branch predilatation was a statistically significant predictor for crossover to 2- stents, OR1.5 [95% CI=1.1-2.3; p=0.02].

Conclusion: Side branch predilatation is the strongest predictor for crossover from one to 2-stents while treating coronary bifurcation lesions.