Abstract:

The article presents case report of step-by-step treatment of patient with coronary arteries disease (CAD). Male, 47 yrs in 1996 underwent aorto-coronary bypass with making of 7 bypasses. Due to progression of atherosclerotic disease in postoperative perion patient underwent percutaneous transluminal coronary angioplastics (PTCA). Despite of all procedures new coronary arteries and bypasses defeat appeared and restenosis of previously implanted stents was pointed. Patient was treated in different countries (Israel, Germany Japan, Russia) with different methods, including: drug-eluting stents, angioplasty with the help of excimer laser and rotational atherectomy Application of physical and mechanical isolation of hyperplastic intima (excimer laser, rotational atherectomy) did not give significant decrease of restenosis repeat. Implantation of drug-eluting stents also had no effect. Stent-in-stent implantation in case of drug-eluting stent restenosis led to repeated restenosis in this patient.

Thus, restenosis is a serious problem for interventional cardiologists. Any of available interventional methods provide optimum direct results, and the long-term results are even poorer.

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Abstract:

Aim: was to determine indications for various methods of stenting on the base of conducted earlier interventions on bifurcation lesions after previously coronary artery occlusion.

Methods. In NRICP we studied a group of patients who underwent PCI for occluded arteries since 2009 to 2011. The study included patients with chronic total occlusion and bifurcation lesion with a diameter of side brunch more than 2 mm and stenosis >50%. Patients were divided into two groups (proximal and distal lesions) with respect of the proximal cap occlusion to the bifurcation. The primary end point was the emergence of MACE during the hospital period, including death, myocardial infarction, or repeat revascularization of the target vessel. Immediate angiographic success was considered in the case of blood flow TIMI II-III after stenting and residual stenosis of less than 50%.

Results. For the period of 2009-2011 PCI was performed. 307 patients were included in the study. The group of proximal lesions included 148 cases. The group of distal lesions consisted of 159 patients. Immediate angiographic success was observed in 98.3% of cases. Deaths, myocardial infarction, cerebrovascular accident, re-PCI, CABG during the hospital period were not noted.

Conclusion. Bifurcation lesions occure in 57,9% of cases after recanalization of chronic occlusions. In both groups one stent technique dominated, but in a group of proximal lesions two stents technique was used 5,8 times more often than in the distal lesions group. In both groups, MACE in hospital period were not noted.

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