Simultaneous kissing drug-eluting stents to treat unprotected left main stem bifurcation disease: medium term outcome in 150 consecutive patients.

Aims: Percutaneous coronary intervention (PCI) is increasingly being used to treat left main stem (LMS) coronary artery disease. Disease at the LMS bifurcation is technically challenging to treat, and there is no consensus as to the best method. We previously described experimental and initial clinical results with the simultaneous kissing stents (SKS) technique in a small series using drug-eluting stents (DES). We now report our results in a larger cohort with long-term follow-up.

Methods And Results: We treated 150 consecutive, unselected patients with unprotected bifurcation LMS with SKS using DES. The patients' mean age was 67 years, 70% were male, 45% were non-elective and 35% were not surgical candidates. The New York Risk Score estimate of in-hospital mortality was (median) 0.7% (IQR 0.3-3.9%), logistic EuroSCORE 3.3% (1.3-11.9%) and angiographic SYNTAX score 20 (15-27). SKS were deployed in 99.3% of cases, and DES in 97%. There was no emergency CABG. The mortality rate at one year was 11.3% and at two years 12.7%. The (ischaemia-driven) target lesion revascularisation rate was 4.3% at one year and 6.2% at two years.

Conclusions: The SKS technique for treating ULMS bifurcation disease is simple, feasible, effective and durable in treating "all-comers" with LMS bifurcation disease. It is a two-stent technique worthy of consideration at the LMS bifurcation.