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Aims: Target lesion revascularization (TLR) rates of bifurcated lesions (BL) remain high, mainly due to side branch (SB) restenosis, even when drug-eluting stents (DES) are used. The aim of our study was to evaluate long-term clinical outcomes of a stepwise approach with single bare metal R stent implantation for BL., Methods and Results: In 465 patients, PCI was performed using a double guide wire, single stent in main branch (MB), and angioplasty of the SB, aiming at an optimal angiographic result of the MB and an optimal functional result (TIMI 3 flow) of the SB. 105 patients were treated for a true bifurcated lesion (TBL) and 360 patients were treated for a lesion with involvement of a significant side branch (ISB). Procedural success was achieved in all TBL and in 99% of ISB. At 1 year clinical follow-up, 8.6% treated for TBL had clinically driven TLR, 7.6% underwent repeat PCI, 1.0% underwent CABG. For patients treated for ISB, 13% had clinically driven TLR, 9.4% underwent repeat PCI, 3.6% CABG. 4 patients treated for TBL suffered non-fatal MI vs. 20 patients treated for ISB. Cardiac death occurred in 1.9% and 2.5 % respectively., Conclusion: A simple approach in the percutaneous treatment of BL using a single bare metal R stent results in good 1 year clinical outcome comparable to the outcome reported following DES implantation.

Background: Acute ST-elevation myocardial infarction (STEMI) is caused by sudden occlusive coronary thrombosis, after plaque disruption; however, a considerable time interval between plaque disturbance and the onset of symptoms has been suggested. We therefore studied the age of intracoronary thrombi, aspirated during angioplasty in patients with acute STEMI., Methods and Results: Percutaneous intracoronary thrombectomy during angioplasty was performed in 211 consecutive STEMI patients within 6 hours after onset of anginal symptoms. The aspirated material was histologically screened on thrombus and plaque components, and thrombus age was classified as fresh (<1 day), lytic thrombus (1 to 5 days), and organized thrombus (>5 days). In all patients, intracoronary-derived material was retrieved in the filter of the collection bottle. Thrombus was identified in 199 (95%) of 211 patients. In 12 patients (5%), only plaque components were identified, and in 85 patients (41%), both thrombus and plaque material were aspirated. In 18 (9%) of 199 patients, the thrombus was organized, and in 70 patients (35%), the thrombus showed lytic changes, whereas in 98 (49%), a completely fresh thrombus was found. In 14 (7%) of 199 patients, the thrombus showed combined features of both fresh thrombus and organized thrombus., Conclusions: In at least 50% of patients with acute STEMI, coronary thrombi were days or weeks old. This indicates that sudden coronary occlusion is often preceded by a variable period of plaque instability and thrombus formation, initiated days or weeks before onset of symptoms.