Advertisement

Herz

, Volume 44, Issue 4, pp 354–362 | Cite as

Final kissing balloon inflation for coronary bifurcation lesions treated with single-stent technique

A meta-analysis
  • G. Liu
  • X. Ke
  • Z.‑B. Huang
  • L.‑C. Wang
  • Z.‑N. Huang
  • Y. Guo
  • M. LongEmail author
  • X.‑X. LiaoEmail author
Original articles

Abstract

Background

The efficacy of final kissing balloon (FKB) inflation in one-stent techniques for bifurcation lesions is controversial. The goal of the present study was to investigate the impact of FKB on long-term clinical outcomes in one-stent strategies.

Methods

A literature search of the PubMed, Embase, and Cochrane Library databases was undertaken through August 2017. The primary outcome was major adverse cardiac events (MACE), defined as the composite of cardiac death, myocardial infarction, and target lesion revascularization. Overall hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated using the random-effects model.

Results

Ten studies comprising 7364 patients treated with a one-stent technique were included in the analysis. Overall, FKB did not demonstrate a significant reduction in MACE compared with non-FKB in both randomized trials (HR: 1.13; 95% CI: 0.65–1.98) and observational studies (HR: 0.86; 95% CI: 0.61–1.20). The risk of cardiac death (HR: 0.89; 95% CI: 0.53–1.49), myocardial infarction (HR: 0.76; 95% CI: 0.53–1.09), and target lesion revascularization (HR: 0.96; 95% CI: 0.74–1.23) was also similar in both groups.

Conclusion

FKB may not be mandatory and a selective FKB strategy might be more justified in one-stent techniques for bifurcation lesions.

Keywords

Coronary artery disease Balloon angioplasty Stents Percutaneous coronary intervention Myocardial ischemia 

Finale Kissing-Balloon-Entfaltung bei Therapie von Läsionen einer Koronarbifurkation mit Single-Stent-Technik

Eine Metaanalyse

Zusammenfassung

Hintergrund

Die Wirksamkeit der finalen Kissing-Balloon(FKB)-Entfaltung im Rahmen des Single-Stent-Verfahrens zur Therapie von Läsionen an einer Koronarbifurkation ist umstritten. Ziel der vorliegenden Studie war es, den Einfluss der FKB auf die klinischen Langzeitergebnisse beim Single-Stent-Verfahren zu untersuchen.

Methoden

Bis einschließlich August 2017 wurde eine Literatursuche in den Datenbanken PubMed, Embase und der Cochrane Library durchgeführt. Primärer Endpunkt waren schwere ungünstige kardiale Ereignisse („major adverse cardiac events“, MACE), die definiert waren als zusammengesetzter Endpunkt aus Herztod, Myokardinfarkt und Revaskularisierung der Zielläsion. Die Gesamt-Hazard-Ratio (HR) und das 95%-Konfidenzintervall (95%-KI) wurden anhand des Random-Effects-Modells ermittelt.

Ergebnisse

In die Auswertung wurden 10 Studien mit 7364 Patienten eingeschlossen, die mittels Single-Stent-Verfahren behandelt wurden. Insgesamt ergab sich weder in randomisierten Studien (HR: 1,13; 95%-KI: 0,65–1,98) noch in Beobachtungsstudien (HR: 0,86; 95%-KI: 0,61–1,20) durch die FKB eine signifikante Verminderung der MACE im Vergleich zur Non-FKB-Therapie. Das Risiko für einen Herztod (HR: 0,89; 95%-KI: 0,53–1,49), Myokardinfarkt (HR: 0,76; 95%-KI: 0,53–1,09) und eine Revaskularisierung der Zielläsion (HR: 0,96; 95%-KI: 0,74–1,23) war ebenfalls in beiden Gruppen ähnlich.

Schlussfolgerung

Die FKB ist möglicherweise nicht unbedingt erforderlich, und eine selektive FKB-Strategie könnte im Rahmen des Single-Stent-Verfahrens bei Läsionen einer Bifurkation eher gerechtfertigt sein.

Schlüsselwörter

Koronare Herzkrankheit Ballonangioplastie Stents Perkutane Koronarintervention Myokardiale Ischämie 

Notes

Compliance with ethical guidelines

Conflict of interest

G. Liu, X. Ke, Z.-B. Huang, L.-C. Wang, Z.-N. Huang, Y. Guo, M. Long, and X.-X. Liao declare that they have no competing interests.

This article does not contain any studies with human participants or animals performed by any of the authors.

References

  1. 1.
    Iakovou I, Ge L, Colombo A (2005) Contemporary stent treatment of coronary bifurcations. J Am Coll Cardiol 46:1446–1455CrossRefGoogle Scholar
  2. 2.
    Hildick-Smith D, de Belder AJ, Cooter N et al (2010) Randomized trial of simple versus complex drug-eluting stenting for bifurcation lesions: the British Bifurcation Coronary Study: old, new, and evolving strategies. Circulation 121:1235–1243CrossRefGoogle Scholar
  3. 3.
    Niemelä M, Kervinen K, Erglis A et al (2011) Randomized comparison of final kissing balloon dilatation versus no final kissing balloon dilatation in patients with coronary bifurcation lesions treated with main vessel stenting: the Nordic-Baltic Bifurcation Study III. Circulation 123:79–86CrossRefGoogle Scholar
  4. 4.
    Katritsis DG, Siontis GC, Ioannidis JP (2009) Double versus single stenting for coronary bifurcation lesions: a meta-analysis. Circ Cardiovasc Interv 2:409–415CrossRefGoogle Scholar
  5. 5.
    Ge L, Airoldi F, Iakovou I et al (2005) Clinical and angiographic outcome after implantation of drug-eluting stents in bifurcation lesions with the crush stent technique: importance of final kissing balloon post-dilation. J Am Coll Cardiol 46:613–620CrossRefGoogle Scholar
  6. 6.
    Ge L, Iakovou I, Cosgrave J et al (2006) Treatment of bifurcation lesions with two stents: one year angiographic and clinical follow up of crush versus T stenting. Heart 92:371–376CrossRefGoogle Scholar
  7. 7.
    Pan M, Medina A, Suárez de Lezo J et al (2011) Coronary bifurcation lesions treated with simple approach (from the Cordoba & Las Palmas [CORPAL] kiss trial). Am J Cardiol 107:1460–1465CrossRefGoogle Scholar
  8. 8.
    Korn HV, Yu J, Ohlow MA et al (2009) Interventional therapy of bifurcation lesions: a TIMI flow-guided concept to treat side branches in bifurcation lesions—a prospective randomized clinical study (Thueringer bifurcation study, THUEBIS study as pilot trial). Circ Cardiovasc Interv 2:535–542CrossRefGoogle Scholar
  9. 9.
    Ahn JM, Lee PH, Park DW et al (2017) Benefit of final kissing balloon inflation mandatory after simple crossover stenting for left main bifurcation narrowing. Am J Cardiol 119:528–534CrossRefGoogle Scholar
  10. 10.
    Gao Z, Xu B, Yang YJ et al (2015) Effect of final kissing balloon dilatation after one-stent technique at left-main bifurcation: a single center data. Chin Med J 128:733–739CrossRefGoogle Scholar
  11. 11.
    Yu CW, Yang JH, Song YB et al (2015) Long-term clinical outcomes of final kissing ballooning in coronary bifurcation lesions treated with the 1‑stent technique: results from the COBIS II registry (Korean coronary bifurcation Stenting registry). JACC Cardiovasc Interv 8:1297–1307CrossRefGoogle Scholar
  12. 12.
    Kim TH, Lee HJ, Jang HJ et al (2014) Impact of final kissing balloon inflation after simple stent implantation for the treatment of non-left main true coronary bifurcation lesions in patients with acute coronary syndrome. Int J Cardiol 177:907–911CrossRefGoogle Scholar
  13. 13.
    Yamawaki M, Muramatsu T, Kozuma K et al (2014) Long-term clinical outcome of a single stent approach with and without a final kissing balloon technique for coronary bifurcation. Circ J 78:110–121CrossRefGoogle Scholar
  14. 14.
    Biondi-Zoccai G, Sheiban I, De Servi S et al (2014) To kiss or not to kiss? Impact of final kissing-balloon inflation on early and long-term results of percutaneous coronary intervention for bifurcation lesions. Heart Vessels 29:732–742CrossRefGoogle Scholar
  15. 15.
    Hariki H, Shinke T, Otake H et al (2013) Potential benefit of final kissing balloon inflation after single stenting for the treatment of bifurcation lesions—insights from optical coherence tomography observations. Circ J 77:1193–1201CrossRefGoogle Scholar
  16. 16.
    Kjaergard LL, Villumsen J, Gluud C (2011) Reported methodologic quality and discrepancies between large and small randomized trials in meta-analyses. Ann Intern Med 135:982–989CrossRefGoogle Scholar
  17. 17.
    Wells GA, Shea B, O’Connell D et al (2012) The newcastle-ottawa scale (NOS) for assessing the quality of Nonrandomised studies in meta-analyses. http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp. Accessed 8 Oct 2012Google Scholar
  18. 18.
    Higgins JP, Thompson SG, Deeks JJ, Altman DG (2003) Measuring inconsistency in meta-analyses. BMJ 327:557–560CrossRefGoogle Scholar
  19. 19.
    Lefèvre T, Louvard Y, Morice MC et al (2000) Stenting of bifurcation lesions: classification, treatments, and results. Catheter Cardiovasc Interv 49:274–283CrossRefGoogle Scholar
  20. 20.
    Ormiston JA, Webster MW, El Jack S et al (2006) Drug-eluting stents for coronary bifurcations: bench testing of provisional side branch strategies. Catheter Cardiovasc Interv 67:49–55CrossRefGoogle Scholar
  21. 21.
    Rahman S, Leesar T, Cilingiroglu M et al (2013) Impact of kissing balloon inflation on the main vessel stent volume, area, and symmetry after side-branch dilation in patients with coronary bifurcation lesions: a serial volumetric intravascular ultrasound study. JACC Cardiovasc Interv 6:923–931CrossRefGoogle Scholar
  22. 22.
    Guérin P, Pilet P, Finet G et al (2010) Drug-eluting stents in bifurcations bench study of strut deformation and coating lesions. Circ Cardiovasc Interv 3:120–126CrossRefGoogle Scholar
  23. 23.
    Otake H, Shite J, Ako J et al (2009) Local determinants of thrombus formation following sirolimus-eluting stent implantation assessed by optical coherence tomography. JACC Cardiovasc Interv 2:459–466CrossRefGoogle Scholar
  24. 24.
    Yamawaki M, Fujita M, Sasaki S et al (2017) Randomized comparison between provisional and routine kissing-balloon technique after main vessel crossover stenting for coronary bifurcation lesions. Heart Vessels 32:1067–1076CrossRefGoogle Scholar
  25. 25.
    Chen SL, Santoso T, Zhang JJ et al (2017) Clinical outcome of double kissing crush versus provisional stenting of coronary artery bifurcation lesions: the 5‑year follow-up results from a randomized and multicenter DKCRUSH-II study (randomized study on double kissing crush technique versus provisional Stenting technique for coronary artery bifurcation lesions). Circ Cardiovasc Interv 10:e4497CrossRefGoogle Scholar
  26. 26.
    Foin N, Torii R, Mortier P et al (2012) Kissing balloon or sequential dilation of the side branch and main vessel for provisional stenting of bifurcations: lessons from microcomputed tomography and computational simulations. JACC Cardiovasc Interv 5:47–56CrossRefGoogle Scholar
  27. 27.
    de Lezo JS, Medina A, Martin P et al (2008) Ultrasound findings during percutaneous treatment of bifurcated coronary lesions. Rev Esp Cardiol 61:930–935CrossRefGoogle Scholar

Copyright information

© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2017

Authors and Affiliations

  1. 1.Department of Cardiology, First Affiliated HospitalSun Yat-sen UniversityGuangzhouChina
  2. 2.Department of CardiologyShenzhen Sun Yat-sen Cardiovascular HospitalShenzhenChina
  3. 3.GuangzhouChina

Personalised recommendations