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.