Abstract:

Aim: was to carry out a comparative evaluation of results of stenting of bifurcation lesions in the segment of coronary chronic total occlusions (CTO) using different methods of percutaneous coronary intervention (PCI).

Materials and methods: present study is based on results of treatment of 146 patients (2010-2013) with coronary artery disease (CAD), who underwent CTO recanalization and had bifurcation with side-branch diameter more than 2mm. After successful recanalization of CTO, patients were randomized into two groups with respect to the used method of stenting: a group with stenting of major vessel and side branch with technique «Mini Crush», and a group with Provisional «Т-stenting» technique. The primary composite endpoint - incidence of major adverse cardiac and cerebrovascular events (MACCE), which includes thrombosis, restenosis, repeated intervention in the target vessel, acute myocardial infarction, stroke and cardiovascular death.

Results: absence of MACCE in the remote period of observation was significantly higher when using and amounted to 87,7% against 63,1% at 12 months after surgery

Conclusions: the use of technique «Mini crush» stenting is more effective (to reduce frequency of post-operative complications, risk of restenosis and repeat intervention in long term) in patients with bifurcation lesions in chronic total occlusion of coronary artery in comparison with using «T-provisional» stenting. 

References 

1.    Popma J., Mauri L., O’Shaughnessy C., et al. Frequency and clinical consequences associated with side branch occlusion during stent implantation using zotarolimus-eluting and paclitaxel-eluting coronary stents. Circ. Cardiovasc. Interv. 2009; 2:133-9.

2.    Colombo A., Moses J., Morice M., et al. The randomized study to evaluate sirolimus-eluting stents implanted in coronary bifurcation lesions. Circ. 2004; 109:1244-9.

3.    Garot P, Lefevre T., Savage M., et al. Nine-month outcome of patients treated by percutaneous coronary interventions for bifurcation lesions in the recent era: a report from the Prevention of Restenosis with Tranilast and its Outcomes (PRESTO) Trial. J. Am. Coll. Cardiol. 2005; 46:606-612.

4.    Nakamura S., Muthusamy T., Bae J., et al. Impact of sirolimus-eluting stent on the outcome of patients with chronic total occlusions: multicenter registry in Asia. J. Am. Coll. Cardiol. 2004; 43:35A.

5.    Werner G., Krack A., Schwarz G., et al. Prevention of lesion recurrence in chronic total coronary occlusions by paclitaxel-eluting stents. J. Am. Coll. Cardiol. 2004; 44: 2301-2306.

6.    Hoye A., Tanabe K., Lemos P, et al. Significant reduction in restenosis after the use of sirolimus-eluting stents in the treatment of chronic total occlusions. J. Am. Coll. Cardiol. 2004; 43: 1954-1958.

7.    Kini A., Lee P, Marmur J., et al. Correlation of post-percutaneous coronary intervention creatine kinase-MB and troponin I elevation in predicting mid-term mortality. Am. J. Cardiol. 2004; 93:18-23.

8.    Osiev A.G., Baystrukov V.I., Biryukov A.V. Taktika endovaskulyarnogo lecheniya pri bifurkacionnom porazhenii posle rekanalizacii khronicheskoy okklyuzii koronarnyh arteriy.[ Endovascular treatment tactics in patients with bifurcation lesions after recanalization of chronic coronary arteries occlusions]. Diagnosticheskaya i intervencionnaya radiologiya. 2013; 7(1): 27-31[In Russ].

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10.  Galassi A., Colombo A., Buchbinder M., et al. Long term outcome of bifurcation lesions after implantation of drug-eluting stents with the «Mini-Crush technique». Catheter. Cardiovasc. Interv. 2007; 69:976-83.

11.  Galassi A., Tomasello S., Capodanno D., et al. «Mini Crush» versus «T-provisional» techniques in bifurcation lesions: clinical and angiographic long-term outcome after implantation of drug-eluting stents. J. Am. Coll. Cardiol. Intv. 2009; 2: 185-94.

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.

References 

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2.    Werner G.S., Krack A., Schwarz G., Prochnau D., Betge S., Figulla HR. Prevention of lesion recurrence in chronic total coronary occlusions by paclitaxel-eluting stents. J. Am. Coll. Cardiol. 2004; 44: 2301-2306.

3.    Valent R.I., Migliorini A., Signorini U., Vergara R., Parodi G., Carrabba N., et al. Impact of complete revascularization with percutaneous coronary intervention on survival in patients with at least one chronic total occlusion. Eur. Heart. J.2008; 29: 2336-2342.

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5.    Christofferson R.D., Lehmann K.G., Martin G.V. et al. Effect of chronic total coronary occlusions on treatment strategy. Am. J. Cardiol. 2005; 95: 1088-91.

6.    Garot P., Lefevre T., Savage M., Louvard Y., Bamlet W.R., Willerson J.T., Morice M.C., Holmes D.R. Jr. Nine-month outcome of patients treated by percutaneous coronary interventions for bifurcation lesions in the recent era: a report from the Prevention of Restenosis with Tranilast and its Outcomes(PRESTO) trial. J. Am Coll. Cardiol. 2005; 46: 606-12.

7.    Colombo A., Moses J.W., Morice M.C., Ludwig J., Holmes D.R. Jr., Spanos V., Louvard Y., Desmedt B., Di Mario C., Leon M.B. Randomized study to evaluate sirolimus-eluting stents implanted at coronary bifurcation lesions. Circulation. 2004; 109:1244-9.

8.    Sharma SK., Sweeny J., Kini A.S. Coronary bifurcation lesions: a current update. Cardiol. Clin. 2010;28:.55-70

9.    Alfredo R. Galassi. Galassi’s Tips & Tricks. Second edition published in Republic of San Marino by Alpha s.r.l. 2010;.275