الفهرس 
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Abstract
Percutaneous coronary intervention (PCI) of bifurcation disease remains a challenge in terms of procedural success rate as well as long term major cardiac events (MACE), target lesion revascularization (TLR), restenosis, and stent thrombosis. Several studies (78 ,93-94) have concluded that stenting the main vessel (MV) with provisional stenting (PS) of side branches (SB) is preferable in the great majority of bifurcation lesions.
Aim of the work:
The aim of this work is to assess the in hospital and mid -term outcome of two different techniques of Stent deployment in bifurcation coronary artery lesions: Two stent technique Vs provisional stenting technique.
Patients and methods:
This study was a prospective non-randomized study performed on 50 patients referred to cardiology department at Beni-Suef University hospital . This study included using two different techniques of Stent deployment (using DES: Drug eluting stents) for elective treatment of stable patients with de nove native bifurcation coronary artery lesions (Provisional stenting technique was used in group I while 2 stent technique was used in group II). Each group included 25 patients
Inclusion Criteria: All stable patients with de novo native coronary bifurcation lesions
Exclusion Criteria:
1- Unprotected left main stenosis ≥ 50%, primary angioplasty for acute ST-elevation myocardial infarction, cardiogenic shock & left ventricular systolic dysfunction.
2- Diameter of the side branch was < 2.25 mm or diameter of the main branch was <2.5 mm.
3- Contraindications for cardiac catheterization or contraindication of dual antiplatelet therapy.
Every patient was subjected to:
1) Complete history taking, 12-lead ECG and echocardiography.
2) Coronary interventional technique: Provisional stenting technique was used in group I while 2 stent technique was used in group II
3) 6 months follow up:
a- Clinical follow up: for major adverse cardiac events (MACE).
b- MPI: for asymptomatic patients or those with atypical symptoms.
c- Coronary angiography: For all patients at 6 months or earlier (if typical ischemic chest pain or Positive stress MPI for ischemia) for evaluation of the previously deployed stent for detection of instent restenosis or stent thrombosis and the need for target vessel revascularization (TVR).
Results:
The primary endpoints: (Mid-term MACE at 6 months)
There was no significant difference as regard angiographic restenosis rates at 6 months between group 1 (8% and 12% in the main branch and side branch, respectively) and group II (4% and 4% in the main branch and side branch, respectively ) with P value ( 0.55 and 0.29 for MB restenosis and SB restenosis ,respectively).
Death during the 6 months follow up period did not occur in any patient in the whole study. Myocardial infarction during the 6 months follow up period occurred in 1 patient (4%) in group I vs. 3 patients ( 12 %) in group II (P = 0.29). Clinically and angiographically driven Target vessel revascularization occurred in 1 patient (4%)in group I vs.2 patients (8%) in group II (P= 0.55). Total composite MACE at 6 months occurred in 2 patients in group I (8%) vs. 4 patients in group II (16%) (P= 0.15).
The secondary endpoints (in hospital MACE):
The immediate in hospital angiographic or procedural success was 100% in all patients in both group, with no in-hospital major complications (MACE ) ; acute myocardial infarction, need for bypass surgery or repeat PCI, or death occurred (P = 1).
The mean procedural time was 68 ± 9.1 minutes in group I and 95 ± 13.6 minutes in group II , with statistical significant difference (P= < 0.001) .The mean amount of contrast used in the procedure was 233.6 ± 33.5 ml in group I and was 288.4 ± 54.7 ml in group II , without statistical significant difference (P= < 0.001).
Conclusion & Recommendations:
In treatment of bifurcation lesions , strategy of DES implantation , Provisional stenting (vs. the Two-stent) strategy lesion yields superior safety as the two stent strategy was associated with significantly longer procedure and fluoroscopy times, higher contrast volumes with no final significant difference regarding MACE in spite of numerical (not statistical) safety differences in favor of provisional strategy due to small number of patients included .
Provisional stenting (vs. the Two-stent) strategy yields similar efficacy as
The immediate angiographic and procedural success was the same ( 100%) in both group with no significant difference as regard angiographic restenosis rates at 6 months.
So, provisional strategy can be recommended as the preferred bifurcation stenting strategy.