Vol 24, No 6 (2017)
Original articles — Interventional cardiology
Published online: 2017-05-19

open access

Page views 1913
Article views/downloads 1623
Get Citation

Connect on Social Media

Connect on Social Media

The approach to coronary bifurcation treatment and its outcomes in Poland: The single center experience

Adam Kern1, Robert J. Gil2, Krystian Bojko3, Bartłomiej Rzeszowski4, Rakesh Jalali5, Jerzy Górny4, Jacek Bil6
Pubmed: 28541601
Cardiol J 2017;24(6):589-596.


Background: Coronary bifurcation lesions pose therapeutic problems during percutaneous coronary interventions. The aim of this study was to analyze the strategy of coronary bifurcation treatment and associated angiographic as well as clinical outcomes in a large hospital in Northern Poland. Methods: Between January 2012 and January 2014 patients with stable coronary artery disease or non-ST-elevation acute coronary syndrome (NSTE-ACS) were treated with regular drug-eluting stents (rDES) or dedicated bifurcation stents (BiOSS Expert® or BiOSS LIM®). Clinical and angiographic controls were planned at 12 months. The primary endpoint was major adverse cardiovascular events (MACE) rate composed of cardiac death, myocardial infarction, and target lesion revascularization (TLR) at 12 months. Results: In total, 152 patients were enrolled in whom 158 stents were deployed (99 BiOSS stents and 59 rDES). Left anterior descending artery (50%) was the dominant target vessel followed by left circum¬flex (25%). There was no stent implantation failure. In 10 (6.3%) patients rDES was required within the side branch. At 12 months MACE rate was 11.2%, whereas TLR rate was 7.9%. In the logistic regression analysis final kissing balloon technique was the prognostic factor for better clinical outcome, whereas NSTE-ACS and true bifurcations were risk factors of a poor outcome. Conclusions: Percutaneous coronary bifurcation treatment is a safe and effective procedure, and pro¬visional T-stenting is the preferred technique. Both rDES as well as dedicated bifurcation stents enabled a simple and fast bifurcation treatment option with comparable MACE and TLR rates. (Cardiol J 2017; 24, 6: 589–596)

Article available in PDF format

View PDF Download PDF file


  1. Chatzizisis YS, Jonas M, Coskun AU, et al. Prediction of the localization of high-risk coronary atherosclerotic plaques on the basis of low endothelial shear stress: an intravascular ultrasound and histopathology natural history study. Circulation. 2008; 117(8): 993–1002.
  2. Song YB, Hahn JY, Yang JH, et al. Differential prognostic impact of treatment strategy among patients with left main versus non-left main bifurcation lesions undergoing percutaneous coronary intervention: results from the COBIS (Coronary Bifurcation Stenting) Registry II. JACC Cardiovasc Interv. 2014; 7(3): 255–263.
  3. Peña-Duque MA, Romero-Ibarra JL, Gaxiola-Macías MB, et al. Coronary atherosclerosis and interventional cardiology. Arch Med Res. 2015; 46(5): 372–378.
  4. Zamani P, Kinlay S. Long-term risk of clinical events from stenting side branches of coronary bifurcation lesions with drug-eluting and bare-metal stents: an observational meta-analysis. Catheter Cardiovasc Interv. 2011; 77(2): 202–212.
  5. Chen L, Fan L, Luo Y, et al. Ex vivo mono-ring technique simplifies culotte stenting for treatment of true bifurcation lesions: Insights from bench testing and clinical application. Cardiol J. 2016; 23(6): 673–684.
  6. Jenei C, Balogh E, Szabó GT, et al. Wall shear stress in the development of in-stent restenosis revisited. A critical review of clinical data on shear stress after intracoronary stent implantation. Cardiol J. 2016; 23(4): 365–373.
  7. Ng AKY, Jim MH. Percutaneous coronary intervention for bifurcation: how can we outperform the provisional strategy? Clin Cardiol. 2016; 39(11): 684–691.
  8. Thygesen K, Alpert JS, Jaffe AS, et al. Third universal definition of myocardial infarction. Circulation. 2012; 126(16): 2020–2035.
  9. Bil J, Gil RJ, Vassilev D, et al. Dedicated bifurcation paclitaxel-eluting stent BiOSS Expert® in the treatment of distal left main stem stenosis. J Interv Cardiol. 2014; 27(3): 242–251.
  10. Gil RJ, Bil J, Vassilev D. The BiOSS stent. EuroIntervention. 2015; 11(Suppl V): V153–V154.
  11. Lassen JF, Holm NR, Banning A, et al. Percutaneous coronary intervention for coronary bifurcation disease: 11th consensus document from the European Bifurcation Club. EuroIntervention. 2016; 12(1): 38–46.
  12. Bil J, Gil RJ, Kern A, et al. Novel sirolimus-eluting stent Prolim® with a biodegradable polymer in the all-comers population: one year clinical results with quantitative coronary angiography and optical coherence tomography analysis. BMC Cardiovasc Disord. 2015; 15: 150.
  13. Finet G, Gilard M, Perrenot B, et al. Fractal geometry of arterial coronary bifurcations: a quantitative coronary angiography and intravascular ultrasound analysis. EuroIntervention. 2008; 3(4): 490–498.
  14. Huo Y, Finet G, Lefèvre T, et al. Optimal diameter of diseased bifurcation segment: a practical rule for percutaneous coronary intervention. EuroIntervention. 2012; 7(11): 1310–1316.
  15. Kim WJ, Kim YH, Park DW, et al. Comparison of single- versus two-stent techniques in treatment of unprotected left main coronary bifurcation disease. Catheter Cardiovasc Interv. 2011; 77(6): 775–782.
  16. Chen SL, Zhang Y, Xu Bo, et al. Five-year clinical follow-up of unprotected left main bifurcation lesion stenting: one-stent versus two-stent techniques versus double-kissing crush technique. EuroIntervention. 2012; 8(7): 803–814.
  17. Vassilev D, Mateev H, Alexandrov A, et al. Double bifurcation optimization stent system technique for left main stenosis. J Interv Cardiol. 2014; 27(6): 570–573.
  18. Murray CD. The physiological principle of minimum work applied to the angle of branching of arteries. J Gen Physiol. 1926; 9(6): 835–841.
  19. Pan M, Medina A, Romero M, et al. Assessment of side branch predilation before a provisional T-stent strategy for bifurcation lesions. A randomized trial. Am Heart J. 2014; 168(3): 374–380.
  20. Niemelä M, Kervinen K, Erglis A, et al. 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. 2011; 123(1): 79–86.
  21. Gil RJ, Bil J, Džavík V, et al. Regular drug-eluting stent vs dedicated coronary bifurcation bioss expert stent: multicenter open-label randomized controlled POLBOS I trial. Can J Cardiol. 2015; 31(5): 671–678.
  22. Takagi K, Ielasi A, Basavarajaiah S, et al. The impact of main branch restenosis on long term mortality following drug-eluting stent implantation in patients with de novo unprotected distal left main bifurcation coronary lesions: the Milan and New-Tokyo (MITO) Registry. Catheter Cardiovasc Interv. 2014; 84(3): 341–348.
  23. Gil RJ, Bil J, Grundeken MJ, et al. Regular drug-eluting stents versus the dedicated coronary bifurcation sirolimus-eluting BiOSS LIM® stent: the randomised, multicentre, open-label, controlled POLBOS II trial. EuroIntervention. 2016; 12(11): e1404–e1412.
  24. Hildick-Smith D, Behan MW, Lassen JF, et al. The EBC TWO Study (European Bifurcation Coronary TWO): A Randomized Comparison of Provisional T-Stenting Versus a Systematic 2 Stent Culotte Strategy in Large Caliber True Bifurcations. Circ Cardiovasc Interv. 2016; 9(9).
  25. Généreux P, Kumsars I, Lesiak M, et al. A randomized trial of a dedicated bifurcation stent versus provisional stenting in the treatment of coronary bifurcation lesions. J Am Coll Cardiol. 2015; 65(6): 533–543.
  26. Magro M, Girasis C, Bartorelli AL, et al. Acute procedural and six-month clinical outcome in patients treated with a dedicated bifurcation stent for left main stem disease: the TRYTON LM multicentre registry. EuroIntervention. 2013; 8(11): 1259–1269.
  27. Briguori C, Visconti G, Donahue M, et al. The STENTYS® paclitaxel-eluting stent in the treatment of unprotected distal left main. Catheter Cardiovasc Interv. 2015; 86(3): E131–E139.
  28. Gil RJ, Bil J, Grundeken MJ, et al. Long-term effectiveness and safety of the sirolimus-eluting BiOSS LIM® dedicated bifurcation stent in the treatment of distal left main stenosis: an international registry. EuroIntervention. 2016; 12(10): 1246–1254.