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The role of intravascular imaging methods during perfomance percutaneous coronary interventions in patients with pseudobifurcation stenosis of the left main coronary artery
Authors : Z Shugushev (Moscow,RU), D A Maximkin (Moscow,RU), A Chepurnoy (Moscow,RU), O Safonova (Moscow,RU), A Faibushevich (Moscow,RU), V Baranovich (Moscow,RU), G Veretnik (Moscow,RU)
Z Shugushev1
,
D A Maximkin1
,
A Chepurnoy1
,
O Safonova1
,
A Faibushevich1
,
V Baranovich1
,
G Veretnik1
,
1RUDN University - Moscow - Russian Federation
,
Aim: to increase the effectiveness of endovascular treatment in patients with ostium coronary artery lesions.
Methods: 150 patients were included in the study. Inclusion criteria: ostium atheros?lerotic lesions of LAD or LCx > 75% according to OCT or IVUS; stable angina II-III functional class (CCS); silent myocardial ischemia. 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.
Results: There were no complications associated with PCI in long-term period results (over a period 30.04±12.04 months). The survival was 100% in all groups. There was no conversion to complete bifurcation stenting. In comparative analysis of Group I and II there were non significant differences of MACE’s and restenosis (2.3 and 7.5% respectively; p>0,05). In group III (without IVUS and OCT) where 18 patients with precision stenting and 22 with Provisional T stenting. There were significant difference for frequency of restenosis in this group (9 and 27.7% respectively; p<0,05). In comparative analysis of Group I and III (n= 22 doing the Provisional T stenting) there were more frequency of restenosis in group III, but this data wasn’t significant difference (0 and 9% respectively p>0,05). However, in comparative analysis of Group II and III (doing the precision stenting) there were significant difference of frequency of restenosis and TLR (2.5 and 22.2% respectively; p<0,05). The data of Minimal lumen area (MLA) in long-term period has significant difference in patients with precision ostium stenting compared to MLA data after PCI (LCx 5.38 vs 4.76 mm2; p<0,05 and LAD 6.28 vs 5.88 mm2; p<0,05). And the results of measuring the LAD and LCx after doing the provisional T stenting in long term period and after PCI were not valuable (p<0,05). Conclusion: the use of intravascular imaging methods 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.
