Randomized comparison of coronary bifurcation stenting with the crush versus the culotte technique using sirolimus eluting stents: the Nordic stent technique study

Andrejs Erglis, Indulis Kumsars, Matti Niemelä, Kari Kervinen, Michael Maeng, Jens F Lassen, Pål Gunnes, Sindre Stavnes, Jan S Jensen, Anders Galløe, Inga Narbute, Dace Sondore, Timo Mäkikallio, Kari Ylitalo, Evald H Christiansen, Jan Ravkilde, Terje K Steigen, Jan Mannsverk, Per Thayssen, Knud Nørregaard Hansen & 7 others Mikko Syvänne, Steffen Helqvist, Nikus Kjell, Rune Wiseth, Jens Aarøe, Mikko Puhakka, Leif Thuesen

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Abstract

BACKGROUND: In a number of coronary bifurcation lesions, both the main vessel and the side branch need stent coverage. Using sirolimus eluting stents, we compared 2 dedicated bifurcation stent techniques, the crush and the culotte techniques in a randomized trial with separate clinical and angiographic end-points. METHODS AND RESULTS: A total of 424 patients with a bifurcation lesion were randomized to crush (n=209) and culotte (n=215) stenting. The primary end point was major adverse cardiac events; cardiac death, myocardial infarction, target vessel revascularization, or stent thrombosis after 6 months. At 6 months there were no significant differences in major adverse cardiac event rates between the groups; crush 4.3%, culotte 3.7% (P=0.87). Procedure and fluoroscopy times and contrast volumes were similar in the 2 groups. The rates of procedure-related increase in biomarkers of myocardial injury were 15.5% in crush versus 8.8% in culotte group (P=0.08). A total of 324 patients had a quantitative coronary assessment at the index procedure and after 8 months. The angiographic end-points of in-segment and in-stent restenosis of main vessel and/or side branch after 8 months were found in 12.1% versus 6.6% (P=0.10) and in 10.5% versus 4.5% (P=0.046) in the crush and culotte groups, respectively. CONCLUSIONS: Both the crush and the culotte bifurcation stenting techniques were associated with similar and excellent clinical and angiographic results. Angiographically, there was a trend toward less in-segment restenosis and significantly reduced in-stent restenosis following culotte stenting.
Original languageEnglish
JournalCirculation. Cardiovascular Interventions
Volume2
Issue number1
Pages (from-to)27-34
Number of pages7
ISSN1941-7640
DOIs
Publication statusPublished - 1. Feb 2009

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Erglis, Andrejs ; Kumsars, Indulis ; Niemelä, Matti ; Kervinen, Kari ; Maeng, Michael ; Lassen, Jens F ; Gunnes, Pål ; Stavnes, Sindre ; Jensen, Jan S ; Galløe, Anders ; Narbute, Inga ; Sondore, Dace ; Mäkikallio, Timo ; Ylitalo, Kari ; Christiansen, Evald H ; Ravkilde, Jan ; Steigen, Terje K ; Mannsverk, Jan ; Thayssen, Per ; Hansen, Knud Nørregaard ; Syvänne, Mikko ; Helqvist, Steffen ; Kjell, Nikus ; Wiseth, Rune ; Aarøe, Jens ; Puhakka, Mikko ; Thuesen, Leif. / Randomized comparison of coronary bifurcation stenting with the crush versus the culotte technique using sirolimus eluting stents: the Nordic stent technique study. In: Circulation. Cardiovascular Interventions. 2009 ; Vol. 2, No. 1. pp. 27-34.
@article{bf755900041411dfaefb000ea68e967b,
title = "Randomized comparison of coronary bifurcation stenting with the crush versus the culotte technique using sirolimus eluting stents: the Nordic stent technique study",
abstract = "BACKGROUND: In a number of coronary bifurcation lesions, both the main vessel and the side branch need stent coverage. Using sirolimus eluting stents, we compared 2 dedicated bifurcation stent techniques, the crush and the culotte techniques in a randomized trial with separate clinical and angiographic end-points. METHODS AND RESULTS: A total of 424 patients with a bifurcation lesion were randomized to crush (n=209) and culotte (n=215) stenting. The primary end point was major adverse cardiac events; cardiac death, myocardial infarction, target vessel revascularization, or stent thrombosis after 6 months. At 6 months there were no significant differences in major adverse cardiac event rates between the groups; crush 4.3{\%}, culotte 3.7{\%} (P=0.87). Procedure and fluoroscopy times and contrast volumes were similar in the 2 groups. The rates of procedure-related increase in biomarkers of myocardial injury were 15.5{\%} in crush versus 8.8{\%} in culotte group (P=0.08). A total of 324 patients had a quantitative coronary assessment at the index procedure and after 8 months. The angiographic end-points of in-segment and in-stent restenosis of main vessel and/or side branch after 8 months were found in 12.1{\%} versus 6.6{\%} (P=0.10) and in 10.5{\%} versus 4.5{\%} (P=0.046) in the crush and culotte groups, respectively. CONCLUSIONS: Both the crush and the culotte bifurcation stenting techniques were associated with similar and excellent clinical and angiographic results. Angiographically, there was a trend toward less in-segment restenosis and significantly reduced in-stent restenosis following culotte stenting.",
author = "Andrejs Erglis and Indulis Kumsars and Matti Niemel{\"a} and Kari Kervinen and Michael Maeng and Lassen, {Jens F} and P{\aa}l Gunnes and Sindre Stavnes and Jensen, {Jan S} and Anders Gall{\o}e and Inga Narbute and Dace Sondore and Timo M{\"a}kikallio and Kari Ylitalo and Christiansen, {Evald H} and Jan Ravkilde and Steigen, {Terje K} and Jan Mannsverk and Per Thayssen and Hansen, {Knud N{\o}rregaard} and Mikko Syv{\"a}nne and Steffen Helqvist and Nikus Kjell and Rune Wiseth and Jens Aar{\o}e and Mikko Puhakka and Leif Thuesen",
year = "2009",
month = "2",
day = "1",
doi = "10.1161/CIRCINTERVENTIONS.108.804658",
language = "English",
volume = "2",
pages = "27--34",
journal = "Circulation. Cardiovascular Interventions",
issn = "1941-7640",
publisher = "Lippincott Williams & Wilkins",
number = "1",

}

Erglis, A, Kumsars, I, Niemelä, M, Kervinen, K, Maeng, M, Lassen, JF, Gunnes, P, Stavnes, S, Jensen, JS, Galløe, A, Narbute, I, Sondore, D, Mäkikallio, T, Ylitalo, K, Christiansen, EH, Ravkilde, J, Steigen, TK, Mannsverk, J, Thayssen, P, Hansen, KN, Syvänne, M, Helqvist, S, Kjell, N, Wiseth, R, Aarøe, J, Puhakka, M & Thuesen, L 2009, 'Randomized comparison of coronary bifurcation stenting with the crush versus the culotte technique using sirolimus eluting stents: the Nordic stent technique study', Circulation. Cardiovascular Interventions, vol. 2, no. 1, pp. 27-34. https://doi.org/10.1161/CIRCINTERVENTIONS.108.804658

Randomized comparison of coronary bifurcation stenting with the crush versus the culotte technique using sirolimus eluting stents: the Nordic stent technique study. / Erglis, Andrejs; Kumsars, Indulis; Niemelä, Matti; Kervinen, Kari; Maeng, Michael; Lassen, Jens F; Gunnes, Pål; Stavnes, Sindre; Jensen, Jan S; Galløe, Anders; Narbute, Inga; Sondore, Dace; Mäkikallio, Timo; Ylitalo, Kari; Christiansen, Evald H; Ravkilde, Jan; Steigen, Terje K; Mannsverk, Jan; Thayssen, Per; Hansen, Knud Nørregaard; Syvänne, Mikko; Helqvist, Steffen; Kjell, Nikus; Wiseth, Rune; Aarøe, Jens; Puhakka, Mikko; Thuesen, Leif.

In: Circulation. Cardiovascular Interventions, Vol. 2, No. 1, 01.02.2009, p. 27-34.

Research output: Contribution to journalJournal articleResearchpeer-review

TY - JOUR

T1 - Randomized comparison of coronary bifurcation stenting with the crush versus the culotte technique using sirolimus eluting stents: the Nordic stent technique study

AU - Erglis, Andrejs

AU - Kumsars, Indulis

AU - Niemelä, Matti

AU - Kervinen, Kari

AU - Maeng, Michael

AU - Lassen, Jens F

AU - Gunnes, Pål

AU - Stavnes, Sindre

AU - Jensen, Jan S

AU - Galløe, Anders

AU - Narbute, Inga

AU - Sondore, Dace

AU - Mäkikallio, Timo

AU - Ylitalo, Kari

AU - Christiansen, Evald H

AU - Ravkilde, Jan

AU - Steigen, Terje K

AU - Mannsverk, Jan

AU - Thayssen, Per

AU - Hansen, Knud Nørregaard

AU - Syvänne, Mikko

AU - Helqvist, Steffen

AU - Kjell, Nikus

AU - Wiseth, Rune

AU - Aarøe, Jens

AU - Puhakka, Mikko

AU - Thuesen, Leif

PY - 2009/2/1

Y1 - 2009/2/1

N2 - BACKGROUND: In a number of coronary bifurcation lesions, both the main vessel and the side branch need stent coverage. Using sirolimus eluting stents, we compared 2 dedicated bifurcation stent techniques, the crush and the culotte techniques in a randomized trial with separate clinical and angiographic end-points. METHODS AND RESULTS: A total of 424 patients with a bifurcation lesion were randomized to crush (n=209) and culotte (n=215) stenting. The primary end point was major adverse cardiac events; cardiac death, myocardial infarction, target vessel revascularization, or stent thrombosis after 6 months. At 6 months there were no significant differences in major adverse cardiac event rates between the groups; crush 4.3%, culotte 3.7% (P=0.87). Procedure and fluoroscopy times and contrast volumes were similar in the 2 groups. The rates of procedure-related increase in biomarkers of myocardial injury were 15.5% in crush versus 8.8% in culotte group (P=0.08). A total of 324 patients had a quantitative coronary assessment at the index procedure and after 8 months. The angiographic end-points of in-segment and in-stent restenosis of main vessel and/or side branch after 8 months were found in 12.1% versus 6.6% (P=0.10) and in 10.5% versus 4.5% (P=0.046) in the crush and culotte groups, respectively. CONCLUSIONS: Both the crush and the culotte bifurcation stenting techniques were associated with similar and excellent clinical and angiographic results. Angiographically, there was a trend toward less in-segment restenosis and significantly reduced in-stent restenosis following culotte stenting.

AB - BACKGROUND: In a number of coronary bifurcation lesions, both the main vessel and the side branch need stent coverage. Using sirolimus eluting stents, we compared 2 dedicated bifurcation stent techniques, the crush and the culotte techniques in a randomized trial with separate clinical and angiographic end-points. METHODS AND RESULTS: A total of 424 patients with a bifurcation lesion were randomized to crush (n=209) and culotte (n=215) stenting. The primary end point was major adverse cardiac events; cardiac death, myocardial infarction, target vessel revascularization, or stent thrombosis after 6 months. At 6 months there were no significant differences in major adverse cardiac event rates between the groups; crush 4.3%, culotte 3.7% (P=0.87). Procedure and fluoroscopy times and contrast volumes were similar in the 2 groups. The rates of procedure-related increase in biomarkers of myocardial injury were 15.5% in crush versus 8.8% in culotte group (P=0.08). A total of 324 patients had a quantitative coronary assessment at the index procedure and after 8 months. The angiographic end-points of in-segment and in-stent restenosis of main vessel and/or side branch after 8 months were found in 12.1% versus 6.6% (P=0.10) and in 10.5% versus 4.5% (P=0.046) in the crush and culotte groups, respectively. CONCLUSIONS: Both the crush and the culotte bifurcation stenting techniques were associated with similar and excellent clinical and angiographic results. Angiographically, there was a trend toward less in-segment restenosis and significantly reduced in-stent restenosis following culotte stenting.

U2 - 10.1161/CIRCINTERVENTIONS.108.804658

DO - 10.1161/CIRCINTERVENTIONS.108.804658

M3 - Journal article

VL - 2

SP - 27

EP - 34

JO - Circulation. Cardiovascular Interventions

JF - Circulation. Cardiovascular Interventions

SN - 1941-7640

IS - 1

ER -