Objective: To estimate the immediate and long-term outcomes after endovascular treatment in patients with Left Main Coronary Artery (LMCA) bifurcation lesions.
Methods: 94 patients were enrolled and randomized in 2 groups. In group I (n = 51) the strategy called "one stent" ("provisional T" technique) was chosen. Patients of group II (n = 43) underwent "two stent" strategy. Final kissing carried out in all patients. Inclusion criteria: presence of true bifurcation lesions of the LMCA (by A. Medina); III-IV functional class of angina; positive stress tests. Indications for endovascular treatment were identified during consultation which was attended by cardiologists, heart surgeons and endovascular surgeons ("heart team"). Only drug eluting stents were used.
Results: Technical success of stenting achieved in all patients of group II (100%) and in 88.3% patients of group I (p>0.05). Hospital survival in both groups was 100%, during hospital stay no MACE cases were observed in both groups. In 6 cases (11.7%) "provisional-T" stenting became unsuccessful due to developing myocardial ischemia and negative ischemic ECG dynamics, thus technique was switched to "two stent" strategy. In all cases "revers culotte" stenting technique was performed. Risk factors of switching from "one stent" to "two stent" technique were identified, the most significant might be considered as: angle of circumflex artery less than 70 degree; length of the circumflex artery lesion more than 5 mm; calcification of the both branches. Long-term outcomes data were gained from 70 patients (36 of group I and 34 of group II). Follow-up duration was 1.5-3 years (avg. 25±1.6 months). Survival in both groups was 100%. Nonfatal myocardial infarction developed in 2 patients of group I (5.5%) and in 1 patient of group II (2.9%) (p > 0.05). Circumflex artery restenosis developed in 25% patients of group I and in 5.8% patients of group II (p<0.001). Frequency of Target Lesion Revascularization (TLR) was 2.9% in group II and 13.8% in group I (p<0.05). Definite late stent thrombosis occurred in 2.7% patients of group I and in 2.9% patients of group II (p>0.05). Patients of group II showed a significant increase in global myocardial contractility, compared to patients undergone "one stent" strategy stenting (59.1±4.44% and 57.34±4.91% resp., p<0.05).
Conclusion: In patients with true LMCA bifurcation stenosis the strategy of "two stents" might be considered as preferable due to significant lower prevalence of in-stent restenosis and TLR, as well as to significant increase in global myocardial contractility.