Predilation of Side Branch During Percutaneous Treatment of Bifurcation Lesions With Provisional T Stenting

NCT ID: NCT01090856

Last Updated: 2014-12-05

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

PHASE4

Total Enrollment

420 participants

Study Classification

INTERVENTIONAL

Study Start Date

2009-02-28

Study Completion Date

2013-05-31

Brief Summary

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Percutaneous treatment of bifurcation lesion is a complex procedure. After main vessel stent implantation, the side branch became jailed and the carina can be displaced resulting in complete occlusion of this vessel. Re-wiring the side branch in this conditions may result difficult and some times impossible. There is no agreement regarding the need of side branch pre-dilation (before main vessel stent implantation) to reduce these complications. Researchers from European Bifurcation Club have proposed no to pre-dilate the side branch to avoid vessel dissection and difficulties in rewiring the true lumen of the vessel. On the contrary, our group has a good experience in the treatment of bifurcation lesions treated with side branch pre-dilation.

Aims: 1.- To determine the efficacy of the side-branch pre-dilation in patients with bifurcations lesions treated with provisional T stenting. 2.- To determine the success rate and incidence of complications in patients with and without side-branch pre-dilation, as well as economic impact in terms of number of used wires.

Detailed Description

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Introduction: Percutaneous treatment of bifurcation lesion is a complex procedure. After main vessel stent implantation, the side branch became jailed and the carina can be displaced resulting in complete occlusion of this vessel. Re-wiring the side branch in this conditions may result difficult and some times impossible. There is no agreement regarding the need of side branch pre-dilation (before main vessel stent implantation) to reduce these complications. Researchers from European Bifurcation Club have proposed no to pre-dilate the side branch to avoid vessel dissection and difficulties in rewiring the true lumen of the vessel. On the contrary, our group has a good experience in the treatment of bifurcation lesions treated with side branch pre-dilation.

Aims: 1.- To determine the efficacy of the side-branch pre-dilation in patients with bifurcations lesions treated with provisional T stenting. 2.- To determine the success rate and incidence of complications in patients with and without side-branch pre-dilation, as well as economic impact in terms of number of used wires.

Design: Prospective and randomized study. Patients and methods: The series is constituted by 420 patients with bifurcations lesions that will be treated with drug-eluting stents; 210 patients will be treated with side branch pre-dilation before main vessels stent implantation, while the remaining 210 patients will be randomized to no pre-dilation of the side-branch.

Primary end point:

* TIMI flow at Side Branch after main vessel stent implantation.

Secondary end points:

* Time of re-wiring.
* Number of used wires.
* % of stenosis at Side Branch.
* Levels of CK and TpI after the procedure.
* Related cardiac events at 9 months. Relevance: Currently there has been controversy over the use of the side branch pre-dilation in patients with bifurcations lesions treated with provisional T-stenting. However, we have no comparative study in the literature.

Conditions

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Coronary Angiography

Keywords

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Bifurcations Drug eluting-stents Provisional stenting

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

FACTORIAL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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No pre-dilation side branch

Group Type NO_INTERVENTION

No interventions assigned to this group

Pre-dilation side branch

Group Type ACTIVE_COMPARATOR

Pre-dilation side branch

Intervention Type PROCEDURE

Balloon pre-dilation of the side branch to facilitate the ulterior wire access.

Interventions

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Pre-dilation side branch

Balloon pre-dilation of the side branch to facilitate the ulterior wire access.

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

* Patients with atherosclerotic coronary disease and bifurcation lesions an significant stenosis of the side branch.
* Main vessels diameter greater than 2.5 mm in diameter at the operator's visual estimate.
* The side branch should exceed 2.25 mm in diameter at the operator's visual estimate.
* Patients with damage to the main branch of any length and the side branch lesions smaller than 5 mm in length.
* Patients with bifurcation lesions fulfilling the following morphologies of the classification of Medina: 1 1 1, 1 0 1, 0 1 1.
* Treatment of bifurcation lesions with previsional drug eluting stents.
* Symptoms of stable angina or acute coronary syndrome.

Exclusion Criteria

* Contraindication to drug eluting stent implantation.
* Cardiogenic shock.
* Coexistence of other serious systemic diseases.
* Patients in whom it is impossible to guide placement in the side branch before stent implantation in the main vessel.
* Patients with bifurcation lesions and side branch less than 2 mm.
Minimum Eligible Age

30 Years

Maximum Eligible Age

85 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Hospital Universitario Reina Sofia de Cordoba

OTHER_GOV

Sponsor Role collaborator

Fundación Pública Andaluza Progreso y Salud

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Manuel Pan Alvarez-Osorio, MD

Role: PRINCIPAL_INVESTIGATOR

Hospital Universitario Reina Sofia de Cordoba

Locations

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Hospital Universitario Reina Sofía

Córdoba, Córdoba, Spain

Site Status

Countries

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Spain

References

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Pan M, Medina A, Suarez de Lezo J, Romero M, Melian F, Pavlovic D, Hernandez E, Segura J, Marrero J, Torres F, et al. Follow-up patency of side branches covered by intracoronary Palmaz-Schatz stent. Am Heart J. 1995 Mar;129(3):436-40. doi: 10.1016/0002-8703(95)90264-3.

Reference Type BACKGROUND
PMID: 7872167 (View on PubMed)

Pan M, Suarez de Lezo J, Medina A, Romero M, Hernandez E, Segura J, Castroviejo JR, Pavlovic D, Melian F, Ramirez A, Castillo JC. Simple and complex stent strategies for bifurcated coronary arterial stenosis involving the side branch origin. Am J Cardiol. 1999 May 1;83(9):1320-5. doi: 10.1016/s0002-9149(99)00093-4.

Reference Type BACKGROUND
PMID: 10235088 (View on PubMed)

Pan M, Suarez de Lezo J, Medina A, Romero M, Segura J, Ramirez A, Pavlovic D, Hernandez E, Ojeda S, Adamuz C. A stepwise strategy for the stent treatment of bifurcated coronary lesions. Catheter Cardiovasc Interv. 2002 Jan;55(1):50-7. doi: 10.1002/ccd.10057.

Reference Type BACKGROUND
PMID: 11793495 (View on PubMed)

Pan M, de Lezo JS, Medina A, Romero M, Segura J, Pavlovic D, Delgado A, Ojeda S, Melian F, Herrador J, Urena I, Burgos L. Rapamycin-eluting stents for the treatment of bifurcated coronary lesions: a randomized comparison of a simple versus complex strategy. Am Heart J. 2004 Nov;148(5):857-64. doi: 10.1016/j.ahj.2004.05.029.

Reference Type BACKGROUND
PMID: 15523318 (View on PubMed)

Pan M, Suarez de Lezo J, Medina A, Romero M, Delgado A, Segura J, Ojeda S, Pavlovic D, Ariza J, Fernandez-Duenas J, Herrador J, Urena I. [Six-month intravascular ultrasound follow-up of coronary bifurcation lesions treated with rapamycin-eluting stents: technical considerations]. Rev Esp Cardiol. 2005 Nov;58(11):1278-86. Spanish.

Reference Type BACKGROUND
PMID: 16324581 (View on PubMed)

de Lezo JS, Medina A, Pan M, Delgado A, Segura J, Pavlovic D, Melian F, Romero M, Burgos L, Hernandez E, Urena I, Herrador J. Rapamycin-eluting stents for the treatment of unprotected left main coronary disease. Am Heart J. 2004 Sep;148(3):481-5. doi: 10.1016/j.ahj.2004.03.011.

Reference Type BACKGROUND
PMID: 15389236 (View on PubMed)

Medina A, Suarez de Lezo J, Pan M. [A new classification of coronary bifurcation lesions]. Rev Esp Cardiol. 2006 Feb;59(2):183. No abstract available. Spanish.

Reference Type BACKGROUND
PMID: 16540043 (View on PubMed)

Pan M, Suarez de Lezo J, Medina A, Romero M, Delgado A, Segura J, Ojeda S, Mazuelos F, Hernandez E, Melian F, Pavlovic D, Esteban F, Herrador J. Drug-eluting stents for the treatment of bifurcation lesions: a randomized comparison between paclitaxel and sirolimus stents. Am Heart J. 2007 Jan;153(1):15.e1-7. doi: 10.1016/j.ahj.2006.10.017.

Reference Type BACKGROUND
PMID: 17174630 (View on PubMed)

Pan M, Medina A, Romero M, Ojeda S, Martin P, Suarez de Lezo J, Segura J, Mazuelos F, Novoa J, Suarez de Lezo J. Assessment of side branch predilation before a provisional T-stent strategy for bifurcation lesions. A randomized trial. Am Heart J. 2014 Sep;168(3):374-80. doi: 10.1016/j.ahj.2014.05.014. Epub 2014 Jun 6.

Reference Type DERIVED
PMID: 25173550 (View on PubMed)

Other Identifiers

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PI 0209/09

Identifier Type: -

Identifier Source: org_study_id