Clinical outcome of treatment with or without a final kissing balloon technique for bifurcation in-stent restenosis lesions

Background: The treatment strategy for in-stent restenosis (ISR) with bifurcation lesions has not been well explored. We examined the clinical outcomes between final kissing balloon technique (FKBT) after stent implantation and single-stent implantation without FKBT for bifurcation ISR lesions. Methods: We identified 115 consecutive ISR with bifurcation lesions among 108 patients who underwent drug-eluting stent implantation. The patients were divided into the FKBT group (34 patients, 35 lesions) and the non-FKBT group (74 patients, 80 lesions). Results: Thrombolysis in myocardial infarction flow grade of side branch was significantly greater in the patients with FKBT than those without FKBT after coronary intervention (2.80 +/- 0.46 vs. 2.65 +/- 0.68, p = 0.04), but this difference was attenuated and was no longer statistically significant at the time of follow-up (2.80 +/- 0.48 vs. 2.80 +/- 0.60, p = 0.97). During a mean follow-up of 47.8 +/- 23.6 months, there were no significant differences in the incidence of major adverse cardiac events (MACE). In multivariate analysis, estimated glomerular filtration rate (hazard ratio: 0.96, 95% confidence interval: 0.92-0.99, p = 0.02) was an independent predictor of MACE. Contrast volume (170.71 +/- 47.17 ml vs. 136.46 +/- 55.56 ml, p = 0.002) and radiation dose (1.44 +/- 1.65 Gy vs. 0.96 +/- 0.46 Gy, p = 0.02) were significantly higher in the FKBT group than in the non-FKBT group. Conclusions: Single-stent implantation without FKBT may be a sufficient treatment strategy for bifurcation ISR lesions. (C) 2016 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.