Long-term results of a modified technique of provisional stenting of bifurcation lesions of coronary arteries

Bazunov A.K., Biryukov A.V., Pelipas’ A.Yu., Koydan A.A., Khubulava G.G., Furgal A.A., Annaev M.S.

Introduction. Stenting of bifurcation lesions of the coronary arteries requires constant adaptation to the challenges of modern interventional cardiology.

Objective. To study the long-term results of surgical treatment of bifurcation lesions of the coronary arteries using a modified provisional stenting technique.

Materials and methods. 90 patients with bifurcation lesions of the coronary arteries were divided into 3 groups by simple randomization. In two groups, provisional stenting was performed using classical techniques (side branch dilation and proximal optimization; kissing dilation with proximal optimization), in the third group, a modified technique was used - local postdilation of the stent cell with proximal optimization. One year after the intervention, angiographic parameters were studied using OCT control, as well as the incidence of deaths, acute cerebrovascular accidents (CVA), stent or arterial thrombosis, re-stenting of vessels, myocardial infarction, and major adverse cardiovascular events (MACE).

Results. Myocardial infarction was detected in 6.6% of patients in each group. The need for repeated revascularization of the target vessel was observed in 10% of patients in the first group, 13.3% in the second, and 6.6% in the third group; repeated revascularization of another vessel was performed in 6.6% of patients in the first and second groups, and 3.3% in the third. Adverse cardiovascular events (MACE) occurred with an acceptably low frequency: in 13.3% in the first and second groups, and in 10% of patients operated on using the modified technique. No statistical differences were found between the groups in terms of angiographic parameters; however, lower values were observed in the third group when assessing restenosis in the main and side branches, late lumen loss in the OB, and total lumen loss in the bifurcation. In addition, the minimum diameter of the main branch was slightly higher in the modified technique group. Repeated OCT monitoring after 12 months showed acceptable values of the minimum vessel size.

Conclusion. The described technique showed acceptable long-term results in the treatment of bifurcation lesions of the coronary arteries and can be considered as an alternative to classical, generally accepted stenting techniques.

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