Randomized Comparison of the Crush Versus the Culotte Stenting for Coronary Artery Bifurcation Lesio

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Background:The crush and the culotte stenting were both reported to be effective for complex bifurcation lesion treatment.However,their comparative performance remains elusive.Methods:A total of 300 patients with coronary bifurcation lesions were randomly assigned to crush (n =150) and culotte (n =150) treatment.The primary endpoint was the occurrence of major adverse cardiac events (MACEs) at 12 months including cardiac death,myocardial infarction,stent thrombosis,and target vessel revascularization.Index lesion restenosis at 12 months was a secondary endpoint.The surface integrals of time-averaged wall shear stress at bifurcation sites were also be quantified.Results:There were no significant differences in MACE rates between the two groups at 12-month follow-up:Crush 6.7%,culotte 5.3% (P =0.48).The rates of index lesion restenosis were 12.7% versus 6.0% (P =0.047) in the crush and the culotte groups,respectively.At 12-month follow-up,the surface integrals of time-averaged wall shear stress at bifurcation sites in the crush group were significantly lower than the culotte group ([5.01 ± 0.95] × 10-4 Newton and [6.08 ± 1.16] × 10 4 Newton,respectively;P =0.003).Conclusions:Both the crush and the culotte bifurcation stenting techniques showed satisfying clinical and angiographic results at 12-month follow-up.Bifurcation lesions treated with the culotte technique tended to have lower restenosis rates and more favorable flow patts.
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