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Primary Results of the Multicenter COBRA trial


European Bifurcation Club 2014 – EBC 2014 – Bordeaux, France

At last randomized trials with dedicated bifurcation stents!

COmplex Coronary Bifurcation Lesions: RAndomized Comparison of a Strategy using a Dedicated Self-Expanding Biolimus A9-eluting Stent vs. a Culotte Strategy using Everolimus-eluting Stents Primary Results of the Multicenter COBRA trial

Author:  Christophe Dubois, MD, PhD, FESC, University Hospital Leuven, Belgium



To compare a dedicated bifurcation stent strategy with a conventional Culotte strategy, assessing:

  • vessel healing using optical coherence tomography (OCT)
  • quantitative coronary angiography (QCA)
  • clinical outcomes


  • True and complex coronary bifurcation lesions can succesfully be treated with both the AXXESS and CULOTTE strategy.
  • We did not observe significant differences in the 1° OCT endpoint of % of uncovered struts at 9 months follow-up between both strategies.
  • We did observe, though, with XIENCE in CULOTTE, a delayed neointimal coverage in the proximal main vessel as compared with more distal segments, related to overlapping stent segments proximally.
  • In contrast, we observed with AXXESS + BIOMATRIX a trend towards a higher percentage of uncovered struts in all bifurca9on segments, despite avoiding overlapping stent segments with this strategy. This finding is most likely related to differences in strut thickness, polymer and antiproliferative drug.
  • As compared with CULOTTE, a strategy using AXXESS in the proximal main vessel resulted in significantly larger lumina, most likely related to more anatomically correct sizing, conical shape and self-expanding properties of the AXXESS device.
  • Both strategies resulted in excellent clinical outcomes at 1 year.


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