Aim: Using objective methods of intravascular imaging to evaluate the results of bifurcation stenting stenosis of the left main coronary artery.
Methods: Three-year results of endovascular treatment of patients with true bifurcation stenosis of the left main coronary artery were evaluated in 94 patients, of whom 48 patients were using one stent technology “provisional-T”, and while 46 were stented “two stent” techniques. All interventions were conduded by final dilation by “kissing-balloon” high pressure balloons and under IVUS guidence. Long-term results were assessed by following criteria: frequency of cardiovascular complications (death, myocardial infarction, re-intervention), IVUS data (residual area of vessel lumen in the proximal segment of left main, zone of bifurcation, the ostia of anterior descending artery and circumflex artery). Decrease in diameter in remaining lumen >70% coas considered as criteria for restenosis.
Results: Survival amongest patients in late period was 97,9%, 2 patients died from non-cardial causes. The frequency of cardiac events in both groups was 8.3 and 4.3%, respectively (p 0,05). Restenosis rate according to IVUS in the body trunk of the left coronary artery and anterior descending artery Stavila 0%. Restenosis of the circumflex artery to IVUS was found to be 14,5% and 4.3% of cases (p 0,001). Repeated revascularization was needed in 4.2% of patients from group 1 and 2.2% in patients of group 2 (p 0,05). Stent thrombosis was not detected in either group. The average residual area of the lumen of the left coronary artery in the proximal part, after “T-provisional” was stenting 7,89+0,03, and after a full bifurcation stenting of 8.0+0.02 mm2 (p 0,05), at the ostia of the circumflex artery 5,62+0,12 and 5,98+0,01 mm2 (p 0,05), at the ostia of the anterior descending artery 6,62+0,03 and 6.78+0,04 mm2. These results did not significantly differ compared to the same 12 months of observation.
Conclusion: The study demonstrates that the use of objective methods of visualization of coronary arteries in patients with bifurcation stenosis of left coronary artery as a method of monitoring the results of stenting, as well as adequate final dilation “kissing balloons” high pressure leads to low frequency of cardiovascular complications and restenosis in long-term period,that have a positive impact on the prognosis of such patients.