Long-term outcome of simultaneous kissing stenting technique with sirolimus-eluting stent for large bifurcation coronary lesions

Objectives: This study was conducted to evaluate the outcomes of simultaneous kissing stenting with sirolimus-eluting stent (SES). Background: Percutaneous intervention for bifurcation coronary lesions is still challenging. Methods: This study was designed to evaluate the long-term outcomes of 36 consecutive patients with large bifurcation coronary lesions who underwent simultaneous kissing stenting with SES. Results: Lesion location was unprotected left main in 29 patients (81%) and anterior descending artery in 7 (19%). The patients received a combination of aspirin and clopidogrel for 6 months and cilostazol for 1 month. Mean proximal reference diameter was 4.05 ± 0.68 mm. Compared with the side branch (SB), the main vessel (MV) involved longer lesions (25.8 ± 17.0 mm vs. 10.2 ± 10.8 mm, P < 0.001) and smaller preprocedural minimal lumen diameters (1.02 ± 0.53 mm vs. 1.46 ± 0.78 mm, P = 0.006) and was treated with larger stents (3.1 ± 0.3 mm vs. 3.0 ± 0.3 mm, P = 0.006). Angiographic success rate was 100%. Over the follow-up of 26.7 ± 8.6 months, no deaths, myocardial infarctions or stent thromboses occurred. Target lesion revascularization was performed in five patients (14%). Overall angiographic restenosis occurred in 5/30 patients (17%), consisting of 4 (13%) at MV and 3 (10%) at SB. At follow-up angiography, a membranous diaphragm at the carina was identified in 14 patients (47%), but only one of whom was associated with angiographic restenosis. Conclusion: Simultaneous kissing stenting with SES appears a feasible stenting technique in large bifurcation coronary lesions. However, a new angiographic structure of carinal membrane developed in a half of patients at follow-up and its influence needs to be further investigated.