Immediate Results of the Evaluation of the Effectiveness of the Modified Technique for Provisional Stenting of Bifurcation Lesions of Coronary Arteries

Introduction. Stenting of bifurcation lesions of the coronary arteries is a pressing issue in interventional cardiology that requires constant adaptation to modern technical advances and patient needs. Optimized treatment methods should take into account morphological features, the potential for plaque formation in the main vessel and in the side branch; ensure long-term efficacy and a low risk of restenosis in the distant period. Objective. To evaluate the immediate results of surgical treatment of bifurcation lesions of the coronary arteries using a modified provisional stenting technique. Materials and methods. In three groups of patients with bifurcation lesions of the coronary arteries, provisional stenting was performed using classical generally accepted techniques (side branch dilation with proximal optimization in the first group and kissing dilation with proximal optimization in the second) and a modified technique i. e. local post-dilation of the stent cell with proximal optimization was used in the third group. After the surgery, we performed OCT control, analyzed in-hospital complications and the following parameters: stenosis of the main and side branches (OCT MB and SB, %); diameter of the main branch (mm); malposition of stent struts (%). Results. When comparing the frequency of major adverse cardiovascular events (MACE), angiographic success in MB and SB, MB predilation, transition to a two-stent technique, as well as the number of stents and guidewires used during the intervention, no statistically significant differences were found in the compared groups. However, when using the modified technique, there was a tendency to reduce the time of X-ray radiation (p=0.37) and the number of balloon catheters used (p=0.55), as well as a decrease in the percentage of malpositioned struts (p=0.31) according to the results of OCT control in comparison with classical techniques. Conclusion. The proposed modified technique of provisional stenting of bifurcation lesions of the coronary arteries is comparable in efficiency and applicability with classical, generally accepted methods of provisional stenting, and also demonstrates ease of implementation and safety in the medium term. The technique demonstrates better geometry of the stented section of neobifurcation; it allows to reduce the risk of thrombosis in the early postoperative period due to complete and optimal adhesion of the stent to the artery.

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