The increased main branch to stent diameter ratio is associated with side branch decreased coronary flow in "true" coronary artery bifurcations treated by "provisional" stenting: A two-dimensional quantitative coronary angiography study

Ilić, Ivan; Vidaković, Radosav; Janićijević, Aleksandra; Stefanović, Milica; Kafedžić, Srdjan; Cerović, Milivoje; Milićević, Dušan; Obradović, Gojko; Jovanović, Vladimir; Stanković, Ivan; Putniković, Biljana; Nešković, Aleksandar N.

doi:10.2298/VSP171228033I

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Vojnosanitetski pregled

2020, vol. 77, br. 1, str. 53-59

Uvećanje odnosa dijametra glavne grane i veličine stenta povezano je sa smanjenim protokom u bočnoj grani kod "pravih" račvi koronarnih arterija lečenih "provizornom" implantacijom stenta - studija sa dvodimenzionalnom kvantitativnom koronarografijom

Ilić Ivan^a, Vidaković Radosav^a, Janićijević Aleksandra^b, Stefanović Milica^b, Kafedžić Srdjan^b, Cerović Milivoje^b, Milićević Dušan^b, Obradović Gojko^b, Jovanović Vladimir^b, Stanković Ivan^a, Putniković Biljana^a, Nešković Aleksandar N.^a

^aUniverzitet u Beogradu, Medicinski fakultet, KBC 'Zemun' + Univerzitet u Beogradu, Medicinski fakultet
^bUniverzitet u Beogradu, Medicinski fakultet, KBC 'Zemun'

e-adresa: ivan1ilic@yahoo.com

Ključne reči: perkutana koronarna intervencija; stentovi; krv, cirkulacija; angiografija koronarnih arterija

Sažetak

Uvod/Cilj. Perkutane koronarne intervencije (PKI) lezija na račvi sa suženjem većim od 50% na glavnoj grani (GG) predstavljaju izazov. Procena dijametara i uglova primenom programa kvantitativne koronarografije (KK) korišćena je u proceni ishoda PKI. Istraživali smo potencijalne efekte "provizorne" implantacije stenta u GG na protok u bočnoj grani (BG) određivanjem kvantitativnih parametara krvnog suda kod "pravih" račvi koje ne zahvataju glavno stablo leve koronarne arterije, primenom 2D KK programa. Metode. Prospektivna studija, sprovedena u univerzitetskom centru sa velikim brojem PKI, uključila je bolesnike sa "pravim" račvama nativnih koronarnih arterija (Medina 1.0.1, 0.1.1, 1.1.1) lečene "provizornom" implantacijom stenta u GG. U studiju nisu bili uključeni bolesnici sa ejekcionom frakcijom (EF) manjom od 30%, klirensom kreatinina manjim od 30 mL/kg/m2 ili lezijom na račvi odgovornoj za infarkt miokarda, hirurški revaskularizovanoj ili prethodno lečenoj primenom PKI. KK analizom mereni su referentni dijametri (RD) GG i BG, stepen dijametar suženja (DS) i uglovi bifurkacija. Rezultati. Studija je uključila 70 bolesnika sa 72 račve. Većina račvi nalazila se u slivu prednje descedentne grane (PDA) - dijagonalna arterija (Dga). Kompromitacija ostijuma BG definisana kao smanjenje koronarnog protoka TIMI < 3 nastala je kod 17/72 (23,6%) račve. Tretirana je angioplastikom ostijuma BG [9/17 (52,9%)] ili implantacijom stenta [8/17 (47,1%)]. U logističkoj regresionoj analizi koja je uključila prethodno poznate prediktore kompromitacije BG (uglovi bifurkacije, RD, DSi odnos GG RD prema dijametru stenta) samo je odnos RD GG prema dijametru stenta bio nezavisni prediktor smanjenje protoka u GG nakon implantacije stenta [OR 2,758 (95% CI 1,298 - 5,862); p = 0,008]. Zaključak. Sniženje koronarnog protoka u bočnoj grani nakon "provizorne" implantacije stenta u glavnu granu, kod "pravih" račvi koronarnih arterija, povezano je sa uvećanim odnosom dijametra glavne grane prema dijametru stenta na osnovu dvodimenzionalne KK.

Abstract

Background/Aim. Percutaneous coronary interventions (PCI) in bifurcation lesions having more than 50% stenosis of both the main branch (MB) and the side branch (SB) remain challenging. Measurements of the vessel diameters and angles using quantitative coronary angiography (QCA) software have been used in evaluating PCI outcomes. We investigated potential effects of provisional stenting of the MB on SB coronary blood flow by determining quantitative vessel parameters in "true" non-left main coronary bifurcation lesions using conventional two-dimensional QCA. Methods. The study was prospective and conducted in a high-volume university PCI center. Study included patients with "true" native coronary artery bifurcations (Medina 1.0.1; 0.1.1; 1.1.1) treated with "provisional" stenting of the MB. Patients were excluded from the study if having left ventricular ejection fraction of less than 30%, having renal failure with creatinine clearance below 30 mL/kg/m2 or bifurcation lesions within the culprit artery causing myocardial infarction, grafted surgically or previously treated by PCI. QCA analysis included measurements of reference vessel diameters (RVD), diameter stenosis (DS) and bifurcation angles. Results. The study included 70 patients with 72 "true" non-left main bifurcations. Most of the bifurcations were located in the left anterior descending (LAD) - diagonal (Dg) territory. Compromise of the SB ostium defined as thrombolysis in myocardial infarction (TIMI) < 3 coronary flow occurred in 17/72 (23.6%) bifurcations. It was treated by either balloon angioplasty only of the SB ostium (9/17, 52.9%) or stent implantation [8/17 (47.1%)]. In a logistic regression analysis, including previously recognized predictors of SB compromise (bifurcation's angles, RVD, DS and ratio of MB RVD to stent diameter ratio), only MB RVD to stent diameter ratio after PCI remained independent predictor of SB coronary flow compromise after stent implantation in the MB [OR 2.758 (95% CI 1.298-5.862); p = 0.008]. Conclusions. It appears that SB decreased coronary blood flow after "provisional" stenting in "true" non-left main bifurcations is associated with greater MB to stent diameter ratio.

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O članku

jezik rada: engleski
vrsta rada: izvorni naučni članak
DOI: 10.2298/VSP171228033I
objavljen u SCIndeksu: 08.02.2020.
metod recenzije: dvostruko anoniman

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