# Stepwise Provisional versus Planned Double Stenting Strategies in Treating Unprotected Left Main Distal Bifurcation Lesions: A Systematic Review and Meta-Analysis Comprising 11,672 Patients

## TL;DR

This study compares two stenting strategies for heart artery blockages and finds differences in risks and outcomes.

## Contribution

A meta-analysis of 11,672 patients clarifying outcomes of provisional versus planned double stenting for unprotected left main bifurcation lesions.

## Key findings

- Provisional stenting reduces major cardiac events but increases cardiac death risk.
- Double stenting lowers cardiac death but increases target vessel revascularization.
- Each strategy has distinct advantages in specific outcomes like MI and stent thrombosis.

## Abstract

Provisional stenting is the preferred strategy for non-left
main bifurcation lesions. However, its superiority over planned double stenting
for unprotected left main distal bifurcation (UPLMB) lesions remains unclear.
Previous studies have reported conflicting results.

Randomised
controlled trials (RCTs) and observational studies comparing the outcomes of
provisional stenting to planned double stenting for UPLMB lesions were
identified. The primary endpoint was major adverse cardiac events (MACE). The
secondary endpoints were myocardial infarction (MI), target vessel
revascularisation (TVR), target lesion revascularisation (TLR), all-cause death,
cardiac death and stent thrombosis (ST). Aggregated odds ratios (OR) and 95%
confidence intervals were calculated. A sensitivity analysis was conducted
if
I2 was >50% or p
< 0.01. Publication bias analysis
was considered if more than 10 studies were enrolled.

Two RCTs
and 19 observational studies comprising 11,672 patients were enrolled.
Provisional stenting had a significantly lower incidence of MACE, mainly driven
by TLR and TVR. Double stenting had a significantly lower incidence of cardiac
death. In addition, patients undergoing provisional stenting had a lower tendency
towards the occurrence of MI, while patients undergoing double stenting had a
lower tendency towards all-cause death and ST.

A provisional stenting strategy was associated with lower MACE,
TVR and TLR but higher cardiac death. Further investigation is needed through
RCTs to assess which strategy performs better.