AUTHOR=Abouelnour Amr EI , Olschewski Maximilian , Makmur Giulio , Ullrich Helen , Knorr Maike , Ahoopai Majid , Münzel Thomas , Gori Tommaso 

TITLE=Six-months clinical and intracoronary imaging follow-up after reverse T and protrusion or double-kissing and crush stenting for the treatment of complex left main bifurcation lesions

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=10

YEAR=2023

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2023.1153652

DOI=10.3389/fcvm.2023.1153652

ISSN=2297-055X

ABSTRACT=<sec><title>Background</title><p>There is a debate regarding the best stent strategy for unprotected distal left main (LM) bifurcation disease. Among two-stent techniques, double-kissing and crush (DKC) is favored in current guidelines but is complex and requires expertise. Reverse T and Protrusion (rTAP) was shown to be a comparable strategy regarding short-term efficacy and safety, but with reduced procedural complexity.</p></sec><sec><title>Aim</title><p>To compare rTAP vs. DKC by optical coherence tomography (OCT) on the intermediate term.</p></sec><sec><title>Methods</title><p>52 consecutive patients with complex unprotected LM stenoses (Medina 0,1,1 or 1,1,1) were randomized to either DKC or rTAP and followed-up for a median of 189[180–263] days for clinical and OCT outcomes.</p></sec><sec><title>Results</title><p>At follow-up OCT showed similar change in the side branch (SB) ostial area (primary endpoint). The confluence polygon showed a higher percentage of malapposed stent struts in the rTAP group that did not reach statistical significance (rTAP: 9.7[4.4–18.3] % vs. DKC: 3[0.07–10.9] %; <italic>p</italic> = 0.064). It also showed a trend towards larger neointimal area relative to the stent area (DKC: 8.8 [6.9 to 13.4] % vs. rTAP: 6.5 [3.9 to 8.9] %; <italic>p</italic> = 0.07), and smaller luminal area (DKC: 9.54[8.09–11.07] mm<sup>2</sup> vs. rTAP: 11.21[9.53–12.42] mm²; <italic>p</italic> = 0.09) in the DKC group. The minimum luminal area in the parent vessel distal to the bifurcation was significantly smaller in the DKC group (DKC: 4.64 [3.64 to 5.34] mm² vs. rTAP: 6.76 [5.20 to 7.29] mm²; <italic>p</italic> = 0.03). This segment also showed a trend for smaller stent areas (<italic>p</italic> = 0.05 to 0.09), and a bigger neointimal area relative to the stent area (DKC: 8.94 [5.43 to 10.5]% vs. rTAP: 4.75 [0.08 to 8.5]%; <italic>p</italic> = 0.06) in the DKC patients. The incidence of clinical events was comparably low in both groups.</p></sec><sec><title>Conclusion</title><p>At 6-months, OCT showed a similar change in the SB ostial area (primary endpoint) in rTAP compared to DKC. There was also a trend for smaller luminal areas in the confluence polygon and the distal parent vessel, and a larger neointimal area relative to the stent area, in DKC, along with a tendency for more malapposed stent struts in rTAP.</p></sec><sec><title>Clinical Trial Registration</title><p><ext-link ext-link-type="uri" xlink:href="https://clinicaltrials.gov/ct2/show/NCT03714750" xmlns:xlink="http://www.w3.org/1999/xlink">https://clinicaltrials.gov/ct2/show/NCT03714750</ext-link>, identifier: NCT03714750.</p></sec>