• Somjot S Brar, William A Gray, George Dangas, Martin B Leon, Vicken J Aharonian, Simerjeet K Brar, and Jeffrey W Moses.
• Columbia University Medical Center, New York, NY, USA. SBrar@cvri.org
• EuroIntervention. 2009 Sep 1; 5 (4): 475-84.

AimsWe sought to determine if outcomes differ between provisional (elective side branch stenting) compared to a routine two-stent strategy (mandatory side branch stenting) for the treatment of bifurcation stenoses of the coronary arteries using drug-eluting stents.Methods And ResultsWe searched Medline, EMBASE, and the Cochrane library from January 2000 to February 2009 for studies comparing the provisional and two-stent strategies. Six randomised controlled trials, including 1,641 patients, were identified. The relative risk (95% confidence interval) for death, MI, target lesion revascularisation, and stent thrombosis within 1-year of the index procedure for a provisional vs. two-stent strategy were 1.12 (0.42-3.02), 0.57 (0.37-0.87), 0.91 (0.61-1.35), and 0.56 (0.23-1.35), respectively. By quantitative coronary angiography, there was no difference in the difference in means (95% CI) between the provisional and two-stent strategies for percent diameter stenosis (95% CI) in the main vessel or side branch, -1.08 (-2.91 to 0.74) and 1.30 (-3.35 to 5.96), respectively.ConclusionWhile death, stent thrombosis, and restenosis were similar between the treatment groups, MI was more common with the two-stent strategy. Thus, compared to a routine two-stent strategy, provisional stenting yields similar efficacy with superior safety and lower costs.

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