COMPARISON OF PROVISIONAL VERSUS TWO-STENT STRATEGY IN TREATING BIFURCATION LESIONS IN STABLE ISCHEMIC HEART DISEASE: A RETROSPECTIVE COHORT STUDY
Main Article Content
Keywords
Provisional stenting, two-stent strategy, bifurcation lesions, stable ischemic heart disease, MACE, coronary artery disease, percutaneous coronary intervention
Abstract
Background:
Bifurcation lesions in coronary arteries represent a complex challenge in interventional cardiology due to their anatomical intricacy and associated procedural risks. Two primary stenting strategies are utilized in patients with stable ischemic heart disease (SIHD) to treat these lesions: the provisional stenting strategy and the two-stent strategy. While the provisional strategy involves stenting the main branch first, followed by the side branch only if necessary, the two-stent strategy is often used in more complex lesions, requiring stenting in both branches. Despite numerous studies, a consensus on the preferred approach remains elusive.
Objective:
This study aims to compare the outcomes of the provisional stenting strategy with the two-stent strategy in patients with bifurcation lesions and SIHD, with a focus on procedural success, major adverse cardiac events (MACE), and secondary outcomes such as procedural time, contrast volume, and hospital stay duration.
Methods:
A retrospective cohort analysis was conducted at a tertiary care center from November 1, 2023, and October 31, 2024. A total of 400 patients with bifurcation lesions were included, with 200 patients receiving provisional stenting and 200 undergoing the two-stent strategy. Data on procedural success, MACE at six months, procedural time, contrast volume used, and hospital stay duration were extracted from medical records and analyzed using SPSS version 25.0.
Results:
Procedural success, defined as TIMI flow grade 3 in both branches, was achieved in 92% of the provisional group and 88% of the two-stent group (p = 0.31). MACE at six months occurred in 5% of the provisional group and 12% of the two-stent group (p = 0.045). The provisional group had significantly shorter procedural times (45 ± 12 minutes vs. 60 ± 15 minutes, p < 0.001) and used less contrast volume (150 ± 35 mL vs. 200 ± 40 mL, p = 0.002).
Conclusion:
The provisional stenting strategy demonstrated comparable procedural success to the two-stent strategy while significantly reducing procedural time, contrast volume, and MACE at six months. These findings suggest that the provisional strategy may be the more efficient and safer approach for managing bifurcation lesions in SIHD.
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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All articles published in JPTCP are licensed under Copyright Creative Commons Attribution-NonCommercial 4.0 International License.
Dr Sardar Bilal Mehboob Abbasi
Senior Registrar, Department of Interventional Cardiology, Armed Forces Institute of Cardiology/National Institute of Heart Diseases, Rawalpindi, Pakistan.
Dr Karimullah Khan
Trainee Registrar of Interventional Cardiology, Peshawar Institute of Cardiology (PIC)
Dr Muhammad Suleman Khan
Assistant Professor Cardiology, Fatima Jinnah Medical University / Sir Ganga Ram Hospital, Lahore, Pakistan
Dr Jamil Hussain
Assistant Professor Cardiology, Gambat Institute of Medical Science, Pakistan
Dr Amjad Ali Hulio
Assistant Professor, Sindh Institute of Cardiovascular Diseases (SICVD) Larkana Centre, Pakistan
Dr Fayaz Ahmed Memon
Professor, Department of Medicine, Muhammed Medical College & Hospital, Mirpurkhas, Sindh, Pakistan,