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The purpose of this study was to determine the long-term (up to 4 years) results of endovascular treatment of patients with true coronary artery bifurcation lesions.
This study enrolled 240 patients. Inclusion criteria were: the presence of true coronary artery bifurcation lesion; side branch diameter more than 2 mm; III and IV functional class of angina. During the first phase of the study all bifurcational lesions were treated with provisional T stenting technique. During the second phase of the study treatment strategy of bifurcational stenting was discussed for every patient prior to intervention. Only drug eluting stents were used. Endpoints of the study were determined as the presence of major adverse cardiac events.
70 patients were enrolled during the I phase of the study. In 9 (12,8%) patients provisional T stenting technique was unsuccessful and “two stent” strategy were used. Technical success of the procedure was observed in 100% of patients. The incidence of death during the hospitalization period was 0%. Risk factors that leads from provisional T stenting strategy to “two stent” strategy were: angle of bifurcation less than 700, length of the side branch lesion more than 2,1 mm, diabetes mellitus, calcinosis of the main and side branch, side branch diameter more than 2,3 mm, age more than 61 years. During the second phase of the study all patients were divided into two groups. I group consists of 132 patients in whom “one stent” strategy was used to treat bifurcational lesion. “Two stent” strategy was used in 38 patients. Survival rate was 97,47% and the incidence of myocardial infarction was 6,25% in the long term follow up period. The rate of restenosis was 2,08% in the side branch and 0% in the main branch. Definite late stent thrombosis was observed in 0,8% of patients. The rate of MACE didn't differ significantly between the “one stent” strategy and “two stent” strategy (10,64% and 5,24%, р=0,172).
The results of this study showed that differentiated approach used for selection and treatment of patients with true coronary artery bifurcational lesions leads to significant increase of clinical success in the long term follow up period.
- 2013 American College of Cardiology Foundation