Randomized Study of the Crush Technique Versus Provisional Side-Branch Stenting in True Coronary Bifurcations The CACTUS (Coronary Bifurcations: Application of the Crushing Technique Using Sirolimus-Eluting Stents) Study
Randomized Study of the Crush Technique Versus Provisional Side-Branch Stenting in True Coronary Bifurcations The CACTUS (Coronary Bifurcations: Application of the Crushing Technique Using Sirolimus-Eluting Stents) Study
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DOI：
10.1161/circulationaha.108.808402
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发表时间：
2009-01-06
期刊：
影响因子：
37.8
通讯作者：
Airoldi, Flavio
中科院分区：
文献类型：
--
作者：
Colombo, Antonio;Bramucci, Ezio;Airoldi, Flavio
背景-西罗莫司洗脱支架已被报道可有效治疗冠状动脉分叉。然而，对于真正的分叉病变，哪种治疗策略能提供最佳的治疗效果还没有完全阐明。方法和结果-CACTUS试验（冠状动脉分叉：使用西罗莫司洗脱支架的挤压技术的应用）是一项前瞻性、随机、多中心研究，比较了2种不同的支架植入技术，强制性最终亲吻球囊充盈，用于真正的分叉：（1）选择性“挤压”支架植入术和（2）仅主分支支架植入术，临时性侧分支T型支架植入术。从2004年8月至2007年6月，350例患者在12个欧洲中心入组。主要血管造影终点为节段内再狭窄率，主要临床终点为6个月时主要不良心脏事件（心源性死亡、心肌梗死或靶血管血运重建）的发生率。6个月时，挤压组（主分支和侧分支分别为4.6%和13.2%）和临时支架植入组（主分支和侧分支分别为6.7%和14.7%; P = NS）的血管造影再狭窄率无差异。在临时支架植入组中，31%的病变需要在侧分支上进行额外支架植入。两组的主要不良心脏事件发生率也相似（挤压组为15.8%，临时支架组为15%，P = NS）。结论：在大多数两支血管均显著狭窄的分叉处，仅在主分支植入支架的临时策略有效，约三分之一的病例需要在侧分支植入第二枚支架。植入2个支架似乎与6个月时不良事件发生率较高无关。（循环。2009; 119：71-78.）
Background-Sirolimus-eluting stents have been reported to be effective in the treatment of coronary bifurcations. Still, it has not been fully clarified which strategy would provide the best results with true bifurcation lesions.Methods and Results-The CACTUS trial (Coronary bifurcations: Application of the Crushing Technique Using Sirolimus-eluting stents) is a prospective, randomized, multicenter study comparing 2 different techniques of stenting, with mandatory final kissing-balloon inflation, in true bifurcations: (1) elective "crush" stenting and (2) stenting of only the main branch, with provisional side-branch T-stenting. From August 2004 to June 2007, 350 patients were enrolled in 12 European centers. The primary angiographic end point was the in-segment restenosis rate, and the primary clinical end point was the occurrence of major adverse cardiac events (cardiac death, myocardial infarction, or target-vessel revascularization) at 6 months. At 6 months, angiographic restenosis rates were not different between the crush group (4.6% and 13.2% in the main branch and side branch, respectively) and the provisional stenting group (6.7% and 14.7% in the main branch and side branch, respectively; P = NS). Additional stenting on the side branch in the provisional stenting group was required in 31% of lesions. Rates of major adverse cardiac events were also similar in the 2 groups (15.8% in the crush group versus 15% in the provisional stenting group, P = NS).Conclusions-In most bifurcations with a significant stenosis in both branches, a provisional strategy of stenting the main branch only is effective, with the need to implant a second stent on the side branch occurring in approximately one third of cases. The implantation of 2 stents does not appear to be associated with a higher incidence of adverse events at 6 months. (Circulation. 2009; 119: 71-78.)