Annette Maznyczka, Sandeep Arunothayaraj, Adrian P Banning, Thomas Schmitz, Adrian Wlodarczak, Marc Silvestri, Mohaned Egred, René Koning, Mark S Spence, Marie-Claude Morice, Thierry Lefevre, Miroslaw Ferenc, James Cockburn, Andrejs Erglis, Philippe Brunel, Francesco Burzotta, Evgeny Kretov, Thomas Hovasse, Manuel Pan, Gerald Clesham, Alaide Chieff, Darren Mylotte, Mitchell Lindsay, Evald H Christiansen, Frédéric Bouisset, Beatriz Vaquerizo, Jens Flensted Lassen, Olivier Darremont, Yves Louvard, Goran Stankovic, David Hildick-Smith
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Restenosis location and its relation to stent technique are poorly characterized. The aim of this study was to investigate restenosis location after LM bifurcation stenting, and the impact of stent implantation technique.</p><p><strong>Methods: </strong>Patients from the EBC MAIN trial who underwent target lesion revascularization during the 3-year follow-up had restenosis location assessed by the core laboratory. Restenosis was defined as ≥50% lesion diameter stenosis.</p><p><strong>Results: </strong>Among 48 patients with target lesion revascularization (mean age 70.3±10.6 years, 72.9% male), 31 were randomized to and treated with upfront dual-stenting, while 17 were randomized to the stepwise provisional technique, of whom 4 had dual-stent implantation. The treatment groups therefore comprised 35 dual-stented and 13 single-stented patients. The commonest pattern of subsequent restenosis was isolated ostial circumflex restenosis (58% of patients), regardless of dual- or single-stent implantation. The ostial circumflex was the culprit lesion for target lesion revascularization in 34 (71%) patients overall (dual- versus single-stented patients: 77% versus 54%; <i>P</i>=0.115). During the 3-year follow-up, the mean % diameter stenosis at the circumflex ostium was similar after dual- versus single-stent implantation (64.6% versus 60.5%, coefficient, -0.12 [95% CI, -0.46 to 0.22]; <i>P</i>=0.473). Single stenting from LM to the circumflex artery was associated with worse subsequent mean % diameter stenosis in the ostium of the left anterior descending artery versus single stenting from LM- left anterior descending (49.8% versus 19.8%, coefficient, 0.57 [95% CI, 0.003-1.13]; <i>P</i>=0.049).</p><p><strong>Conclusions: </strong>The circumflex ostium is the commonest site requiring revascularization after LM bifurcation stenting, irrespective of whether 1 or 2 stents were deployed. Strategies are needed to improve the long-term success of percutaneous coronary intervention to the circumflex artery ostium.</p><p><strong>Registration: </strong>URL: https://www.clinicaltrials.gov; Unique identifier: NCT02497014.</p>","PeriodicalId":10330,"journal":{"name":"Circulation: Cardiovascular Interventions","volume":" ","pages":"e015546"},"PeriodicalIF":7.4000,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Patterns of Restenosis After Left Main Bifurcation Single- or Dual-Stenting: An EBC MAIN Trial Subanalysis.\",\"authors\":\"Annette Maznyczka, Sandeep Arunothayaraj, Adrian P Banning, Thomas Schmitz, Adrian Wlodarczak, Marc Silvestri, Mohaned Egred, René Koning, Mark S Spence, Marie-Claude Morice, Thierry Lefevre, Miroslaw Ferenc, James Cockburn, Andrejs Erglis, Philippe Brunel, Francesco Burzotta, Evgeny Kretov, Thomas Hovasse, Manuel Pan, Gerald Clesham, Alaide Chieff, Darren Mylotte, Mitchell Lindsay, Evald H Christiansen, Frédéric Bouisset, Beatriz Vaquerizo, Jens Flensted Lassen, Olivier Darremont, Yves Louvard, Goran Stankovic, David Hildick-Smith\",\"doi\":\"10.1161/CIRCINTERVENTIONS.125.015546\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>In the randomized EBC MAIN trial (European Bifurcation Club Left Main Coronary Stent), target lesion revascularization at 3 years poststenting of left main (LM) bifurcations was more frequent with upfront dual-stenting compared with the stepwise provisional approach. Restenosis location and its relation to stent technique are poorly characterized. The aim of this study was to investigate restenosis location after LM bifurcation stenting, and the impact of stent implantation technique.</p><p><strong>Methods: </strong>Patients from the EBC MAIN trial who underwent target lesion revascularization during the 3-year follow-up had restenosis location assessed by the core laboratory. Restenosis was defined as ≥50% lesion diameter stenosis.</p><p><strong>Results: </strong>Among 48 patients with target lesion revascularization (mean age 70.3±10.6 years, 72.9% male), 31 were randomized to and treated with upfront dual-stenting, while 17 were randomized to the stepwise provisional technique, of whom 4 had dual-stent implantation. The treatment groups therefore comprised 35 dual-stented and 13 single-stented patients. 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引用次数: 0
摘要
背景：在随机的EBC MAIN试验（欧洲分支俱乐部左主干冠状动脉支架）中，与分步临时入路相比，前置双支架植入术在左主干（LM）分支植入术后3年的靶病变重建术更为频繁。再狭窄的位置及其与支架技术的关系尚不清楚。本研究的目的是探讨LM分叉支架植入术后再狭窄的位置，以及支架植入术的影响。方法：来自EBC MAIN试验的患者在3年随访期间接受了靶病变血运重建术，并由核心实验室评估再狭窄位置。再狭窄定义为病变直径≥50%的狭窄。结果：48例靶病变血运重建术患者（平均年龄70.3±10.6岁，男性72.9%）中，31例随机接受前期双支架治疗，17例随机接受逐步暂置技术治疗，其中4例行双支架植入术。因此，治疗组包括35例双支架患者和13例单支架患者。随后最常见的再狭窄模式是孤立性口旋再狭窄（58%的患者），无论双支架植入还是单支架植入。在34例（71%）患者中（双支架vs单支架患者：77% vs 54%； P=0.115），口旋是靶病变血运重建的罪魁祸首。在3年随访期间，双支架与单支架植入后，旋口狭窄的平均直径百分比相似（64.6% vs 60.5%，系数为-0.12 [95% CI, -0.46 ~ 0.22]； P=0.473）。与LM-左前降支单支架术相比，LM-左前降支单支架术术后左前降支口平均%直径狭窄更严重（49.8%对19.8%，系数0.57 [95% CI, 0.003-1.13]； P=0.049）。结论：无论放置1个或2个支架，旋口是LM分叉支架置入后最常见的需要血运重建的部位。需要一些策略来提高经皮冠状动脉绕道口介入治疗的长期成功率。注册：网址：https://www.clinicaltrials.gov；唯一标识符：NCT02497014。
Patterns of Restenosis After Left Main Bifurcation Single- or Dual-Stenting: An EBC MAIN Trial Subanalysis.
Background: In the randomized EBC MAIN trial (European Bifurcation Club Left Main Coronary Stent), target lesion revascularization at 3 years poststenting of left main (LM) bifurcations was more frequent with upfront dual-stenting compared with the stepwise provisional approach. Restenosis location and its relation to stent technique are poorly characterized. The aim of this study was to investigate restenosis location after LM bifurcation stenting, and the impact of stent implantation technique.
Methods: Patients from the EBC MAIN trial who underwent target lesion revascularization during the 3-year follow-up had restenosis location assessed by the core laboratory. Restenosis was defined as ≥50% lesion diameter stenosis.
Results: Among 48 patients with target lesion revascularization (mean age 70.3±10.6 years, 72.9% male), 31 were randomized to and treated with upfront dual-stenting, while 17 were randomized to the stepwise provisional technique, of whom 4 had dual-stent implantation. The treatment groups therefore comprised 35 dual-stented and 13 single-stented patients. The commonest pattern of subsequent restenosis was isolated ostial circumflex restenosis (58% of patients), regardless of dual- or single-stent implantation. The ostial circumflex was the culprit lesion for target lesion revascularization in 34 (71%) patients overall (dual- versus single-stented patients: 77% versus 54%; P=0.115). During the 3-year follow-up, the mean % diameter stenosis at the circumflex ostium was similar after dual- versus single-stent implantation (64.6% versus 60.5%, coefficient, -0.12 [95% CI, -0.46 to 0.22]; P=0.473). Single stenting from LM to the circumflex artery was associated with worse subsequent mean % diameter stenosis in the ostium of the left anterior descending artery versus single stenting from LM- left anterior descending (49.8% versus 19.8%, coefficient, 0.57 [95% CI, 0.003-1.13]; P=0.049).
Conclusions: The circumflex ostium is the commonest site requiring revascularization after LM bifurcation stenting, irrespective of whether 1 or 2 stents were deployed. Strategies are needed to improve the long-term success of percutaneous coronary intervention to the circumflex artery ostium.
期刊介绍：
Circulation: Cardiovascular Interventions, an American Heart Association journal, focuses on interventional techniques pertaining to coronary artery disease, structural heart disease, and vascular disease, with priority placed on original research and on randomized trials and large registry studies. In addition, pharmacological, diagnostic, and pathophysiological aspects of interventional cardiology are given special attention in this online-only journal.
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