Background: There is controversy concerning the optimal stenting strategy in distal unprotected left main coronary artery (ULMCA) stenosis.
Aim of the Work: To compare provisional stenting (PS), double kissing (DK) crush, and T and protrusion (TAP) stenting techniques in distal ULMCA stenosis.
Patient and Methods: This cohort study enrolled 150 patients scheduled for percutaneous coronary intervention (PCI) and stenting with PS, TAP, and DK crush techniques. Quantitative coronary angiography (QCA) assessment was done for distal left main (LM), left circumflex (LCX), and left anterior descending (LAD) arteries pre-PCI, post-PCI, and during follow-up.
Results: Post-PCI QCA revealed a significantly higher median percentage of in-stent residual stenosis in PS compared to TAP and DK crush groups in the distant LM (3.2% vs. 2 and 2.1%, p=0.001) and proximal LAD (2.5% vs. 1.8 and 2.4%, p=0.022, respectively), but not in LCX (p=0.185). Twelve-months later, no significant differences of in-stent restenosis percentage in distant LM and proximal LAD were observed, while the PS group had a significantly higher in-stent restenosis percentage of proximal LCX (21.5 vs. 12 and 11%, respectively, p < 0.001). The time to revascularization was significantly shorter in PS than TAP and DK groups (p=0.008).
Conclusion: TAP and DK crush techniques are recommended over PS in proximal LCX. PS or two-stent techniques can be used in distal LM and proximal LAD without significant differences in restenosis. Further studies are needed to confirm the superiority of two-stent techniques over the PS in individual vessels.