• Hiroyoshi Kawamoto, Kensuke Takagi, Alaide Chieffo, Neil Ruparelia, Yusuke Fujino New Tokyo Hospital, Chiba, Japan., Hiroto Yabushita, Yusuke Watanabe, Azeem Latib, Mauro Carlino, Matteo Montorfano, Sunao Nakamura, and Antonio Colombo.
• Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy.
• Catheter Cardiovasc Interv. 2017 Jan 1; 89 (1): 13-24.

ObjectivesThis study aimed to investigate the long-term outcomes following mini-crush versus culotte stenting with drug-eluting stents (DES) for the treatment of unprotected left main coronary artery (LMCA) disease.BackgroundBoth mini-crush and culotte stenting are considered efficacious treatment options when a planned 2-stent strategy is deemed necessary for unprotected LMCA disease. However, there are limited data available with regard to the long-term clinical outcomes of each strategy in this setting.MethodsBetween July 2002 and November 2013, 225 patients were identified. 135 patients were treated with the mini-crush technique, and 90 patients with culotte stenting. The median follow-up period was 1,263 (IQR 820-1,847) days.ResultsThe mini-crush group had worse lesion and procedural characteristics when compared to the culotte group. There were no significant differences in major adverse cardiac events (MACE) at 5 years (mini-crush 36.0% vs. culotte 41.4%, P = 0.57). Myocardial infarction (MI) and definite stent thrombosis (ST) occurred significantly higher (MI; 0 vs. 11.3%, log-rank P = 0.003, and definite ST; 0 vs. 6.3%, log-rank P = 0.02, respectively) in the culotte group. Cox regression analysis indicated that full stent coverage of the LMCA and SYNTAX score were independent predictors for MACE.ConclusionsThe incidence of MACE and overall TLR were comparable between groups. However, the rates of MI and definite ST were significantly higher in the culotte group. Full stent coverage of the LMCA may reduce the incidence of MACE when a two-stent strategy is used for the treatment of unprotected LMCA disease. © 2016 Wiley Periodicals, Inc.© 2016 Wiley Periodicals, Inc.

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