Mini-crush vs. T-provisional techniques in bifurcation lesions


A study performed to assess the clinical and angiographic long-term outcome after implanting drug-eluting stents in bifurcation lesions with the T-provisional and mini-crush techniques showed that both met high procedural success with low complication rates and similar major adverse cardiac event long-term outcome. However, the mini-crush technique yields a lower restenosis rate at both main and side branches.

“These results may confirm the advantage of using prescheduled two-stent technique to give a complete coverage of the side branches’ ostium,” the authors wrote. The results were published in the March issue of JACC Cardiovascular Interventions. The research was led by Dr Alfredo R Galassi, Ferrarotto Hospital, University of Catania, Catania, Italy.

From April 2004 to July 2006, 457 patients were consecutively treated with either mini-crush technique (n=199) or T-provisional technique (n=258). Of these latter, 170 patients were treated with one stent and 88 patients with two stents. The nine-month angiographic follow-up was completed in 188 of 229 (82.1%) bifurcation lesions of mini-crush patients and in 207 of 266 lesions (77.8%) of T-provisional patients.

After a propensity score adjustment, two-year cumulative major adverse cardiac events were similar between groups (p=.16). The mini-crush group compared with the T-provisional one-stent group had significantly lower main (hazard ratio [HR]: .52, 95% confidence interval [CI]: .27 to .99; p=.047) and side branches restenosis (HR: .41, 95% CI: .20 to .85; p=.016). However, the mini-crush group compared with the T-provisional-only group had significantly lower side branch restenosis (HR: .55, 95% CI: .37 to .82; p=.004).