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Minerva Cardiology and Angiology 2023 February;71(1):51-60

DOI: 10.23736/S2724-5683.21.05875-0


lingua: Inglese

Twelve-month clinical outcomes of “nano-crush technique” for the treatment of bifurcation lesions using ultra-thin (60 µm) sirolimus-eluting coronary stents

Santosh K. SINHA 1 , Prakash KUMAR 2, Umeshwar PANDEY 1, Puneet AGGARWAL 3, Mahmodullah RAZI 1, Awadesh K. SHARMA 1, Mukesh JHA 1, Mohit SACHAN 1, Praveen SHUKLA 1, Ramesh THAKUR 1, Vinay KRISHNA 1, Priyam MUKHERJEE 4, Suman KARMAKAR 4, Prithwiraj BHATTACHARJEE 4, Shuvanan RAY 4

1 Department of Cardiology, LPS Institute of Cardiology, G.S.V.M. Medical College, Kanpur, India; 2 Department of Cardiology, Rajendra Institute of Medical Science, Ranchi, India; 3 Department of Cardiology, Dr. Ram Manohar Lohia Hospital, New Delhi, India; 4 Department of Cardiology, Fortis Hospital Anandapur, Kolkata, India

BACKGROUND: Provisional stenting is preferred for bifurcation lesion; however, certain anatomical substrate does require two stents as a part of dedicated stent technique. Here, the present study evaluated outcomes of ultra-thin (60 µm) Supra family sirolimus-eluting stent (SES) (Sahajanand Medical Technologies Limited, Surat, India) for dedicated bifurcation lesions using nano-crush technique at 12 months angiographic follow-up.
METHODS: This was prospective, single-center observational study which enrolled patients with de novo bifurcation lesion and underwent angioplasty with Supra family SES using nano-crush technique at a tertiary care center in India, between March-2017 and February-2019. Primary endpoint at 12 months was target lesion failure (TLF), a composite of cardiac death, target vessel myocardial infarction (TV-MI), and clinically driven target lesion revascularization (CD-TLR). Secondary endpoints included patient-oriented composite endpoint (POCE), all-cause death, any revascularization, clinically driven target vessel revascularization, stent thrombosis, periprocedural and spontaneous MI, and device failure.
RESULTS: The study enrolled total 63 patients with a mean age of 62.5±4.9 years and had male dominance (89%). Left main (LM) bifurcation and non-LM bifurcation were observed in 21 (33%) and 42 (67%) patients, respectively. Total 50 (80%) patients had Medina class- 1,1,1. At 12 months, TLF occurred in 4 (6%) patients which included one cardiac death (1.5%), two (3.0%) TV-MI, and one CD-TLR (1.5%). POCE was observed in 6 (9.6%) patients. Stent failure was seen in 2 (3.1%) patient and one patient (1.5%) developed late stent thrombosis. Twelve months angiographic follow-up indicated intact stent patency in all other patients. On multivariate analysis, LM bifurcation, renal dysfunction, LM bifurcation with renal dysfunction, ejection fraction (<35%) and calcified lesion were found as predictors of TLF.
CONCLUSIONS: Dedicated stenting with ultra-thin Supra family SES for complex bifurcation lesion using nano-crush technique reported acceptable clinical outcomes among real-world patients and can be performed safely with ease without any procedural complications.

KEY WORDS: Coronary artery disease; Drug-eluting stents; Percutaneous coronary intervention

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