Outcomes and challenges of the provisional stenting technique: Insights from the PROGRESS-BIFURCATION registry

Bahadir Simsek, Spyridon Kostantinis, Judit Karacsonyi, Salman Allana, Evangelia Vemmou, Ilias Nikolakopoulos, Martin Nicholas Burke, Santiago Garcia, Yale Wang, Ivan Chavez, Mario Gössl, Paul Sorajja, Michael Mooney, Anil Poulose, Yader Sandoval, Jay Traverse, Bavana Venkata Rangan, Emmanouil S. Brilakis

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Provisional stenting is the most commonly used coronary bifurcation stenting strategy. Methods: We examined the clinical and angiographic characteristics, challenges encountered, and procedural outcomes with the provisional bifurcation stenting strategy in the Prospective Global Registry of Percutaneous Coronary Intervention (PCI) in Bifurcation Lesions (PROGRESS-BIFURCATION, NCT05100992). Results: Provisional stenting was used in 334 of 430 bifurcation interventions (78%). Technical success was lower (95% vs. 100%, p = 0.017) in provisional, but procedural success (90% vs. 95%, p = 0.095) and incidence of in-hospital major adverse cardiovascular events were similar (5% vs. 5%, p = 0.945) compared with two-stent strategies. Provisional was less often preferred in left main/left anterior descending involvement (47% vs. 73%, p < 0.001). Provisional stenting cases had smaller side branch (SB) diameter (2.4 ± 0.5 vs. 2.7 ± 0.6 mm, p < 0.001), shorter SB lesion length (5 [3−8] vs. 10 [5−10] mm, p < 0.001), less SB diameter stenosis (46 ± 35 vs. 81 ± 20%, p < 0.001), and were less likely to be Medina 1,1,1 (34% vs. 73%, p < 0.001). PCI challenges were less common (30% vs. 58%, p < 0.001) with provisional stenting: (1) rewiring difficulty (43%) that was overcome with use of a different wire (74%) or microcatheter (46%); (2) inability to deliver a stent (22%) or balloon (9%) that was overcome with use of a smaller balloon (88%), rewiring (25%), or increased support/microcatheter (25%). Conclusions: Provisional bifurcation stenting was more often performed in distal lesions with less SB involvement and had lower technical success, but similar procedural success and complications compared with two-stent strategies.

Original languageEnglish (US)
JournalCatheterization and Cardiovascular Interventions
DOIs
StateAccepted/In press - 2022

Keywords

  • bifurcation
  • percutaneous coronary intervention
  • provisional stenting
  • two-stent strategies.

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

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