Methods: 150 patients were included in the study. Inclusion criteria: ostium atheroslerotic lesions of LAD or LCx > 70% according to QSA and IVUS; stable angina II-III functional class (CCS); silent myocardial ischemia; positive stress test. The main included 108 patients, who were randomized into 2 groups. In I group (n=54) according to IVUS, atherosclerotic plaque spread from the ostium of LAD and/or LCx to the LMCA, and in group II (n = 54) - the plaque did not spread into the LMCA. In Group I all patients were initially treated with «Provisional T» stenting of the LMCA, and in Group II - stenting of the ostium LAD or LCx. In retrospectively, the third (III) control group (n=42) was formed, where the stenting of the ostium of LAD or LCx was performed without IVUS. Drug-eluting stents were implanted in all patients. Long-term results were evaluated on average over a period of 30.04±12.04 months in 50 patients from group I, in 48 patients from group II and in 40 - from group III. Primary endpoints: frequency of MACE (death, MI, revascularizations). Secondary endpoints: frequency of restenosis and late stent thrombosis according to QSA and IVUS.
Results: during hospitalization of complications associated with PCI was not, survival was 100% in all groups. There was no conversion to complete bifurcation stenting. Survival in the long-term period was 100% in all groups. In all patients, in comparison with preoperative data, tolerance to physical activity significantly increased. Nonfatal MI was observed in 7.5% of patients from group III (p <0.05), in the I and II group of cases MI was not recorded. The incidence of stent restenosis and target lesion revascularization (TLR) according to QSA and IVUS was observed in 1 patient (2%) in group I, in 1 patient (2.1%) in group II and in 4 patients (10%) in III group (p<0.05). Frequency of target vessel revascularization (TVR) occurred in group I in 2% of patients, in group II in 2.1%, and in group III in 7.5% (p<0.05). The total frequency of MACE in groups I, II and III was 2; 2.1 and 25%, respectively (p <0.05). Among patients in group III, 1 case of stent thrombosis (2.5%) was verified 12 months after PCI.
Conclusion: the use of IVUS for the analysis of the ostium lesions of coronary artery allows us to choose the optimal stenting technique and also reliably improve the long-term results of endovascular intervention by reducing the incidence of stent restenosis and MACE.