A New Approach to the Assessment of the Results of Endovascular Correction of Coronary Artery Bifurcation

The aim of the investigation is to study the results of endovascular treatment of patients with coronary bifurcation disorders performed under the control of selective coronography and intravascular manometry, and to assess on the basis of their analysis the manometric findings of blood flow in bifurcation branches when choosing endovascular correction management.

Materials and Methods. The analysis of peculiarities and the results of endovascular correction of coronary bifurcations was performed in 67 patients with test T-stenting. The bifurcation state of the 1st group patients (n=32) was assessed by contrast angiography and the measurement of fractional flow reserve, the patients of the 2nd group (n=35) — by angiography findings only. Long-term results (follow-up period is 12 months) were studied in 30 patients (93.8%) of the 1st group, and in 33 patients (94.3%) of the 2nd group.

Results. In 11 of 32 cases angiographic assessment of stenosis in the lateral branch mouth was different from that of manometric one. There was determined an average degree of correlation (R=0.46; р=0.008). In Y-type bifurcation there was no correlation between the assessments of hemodynamic significance of stenosis in the lateral branch (R=0.21; р=0.464). In a follow-up period, angina recurrence or the increase of its degree was revealed in 3 patients (10.0%) of the 1st group, and in 11 patients (33.3%) of the 2nd one (р=0.035). Restenoses in lateral branches were found in 2 patients (6.7%) of the group under study and in 10 patients (30.3%) in the control group (р=0.024).

Conclusion. The use of complex approach to the assessment of the results of coronary bifurcation correction improves the results of surgeries due to the decrease of restenoses rate and the necessity of re-revascularization in the follow-up. The advantage of the approach is more accurate assessment of hemodynamic changes in bifurcation branches and, therefore, the possibility to choose an optimal technique of endovascular correction.

1. Babunashvili A.M., Kartashov D.S., Kavteladze Z.A. et al. Mezdunar Z Interv Kardioangiol — International Journal of Interventional Cardiology 2008; 14: 16.
2. Ganyukov V.I., Tarasov R.S., Susoev N.I. et al. Mezdunar Z Interv Kardioangiol — International Journal of Interventional Cardiology 2008; 14: 23–24.
3. Hoye A., van Mieghem C.A., Ong A.T. et al. Treatment of de novo bifurcation lesions: comparison of Sirolimus- and Paclitaxel-eluting stents. Eurointervention 2005; 1(1): 24–30.
4. Steigen T.K., Maeng M., Wiseth R. et al. Randomized study on simple versus complex stenting of coronary artery bifurcation lesions: the Nordic bifurcation study. Circulation 2006; 114: 1955–1963.
5. Morice M.-C. Bifurcation lesions: a never-ending challenge. European Heart Journal 2009; 29(23): 2831–2832.
6. Alekyan B.G., Staferov A.V. Selektivnaya koronarografiya. V kn.: Rukovodstvo po rentgenoendovaskulyarnoy khirurgii serdtsa i sosudov. Tom 3. Rentgenoendovaskulyarnaya khirurgiya ishemicheskoy bolezni serdtsa [Selective coronography. In: Guide to X-ray endovascular surgery of heart and vessels. Vol 3. X-ray endovascular surgery of coronary heart disease]. Pod red. Bokeriya L.A., Alekyana B.G. [Bokeriya L.A., Alekyana B.G. (editors)]. Moscow: Izdatel’stvo NTsSSKh im. A.N. Bakuleva RAMN; 2008; p. 18–62.
7. Pijls N.H., Bruyne B., Peels K. et al. Measurement of fractional flow reserve to assess the functional severity of coronary artery stenosis. N Engl J Med 1996; 334: 1703–1708.
8. Koo B.-K., Kang H.J., Youn T.J. et al. Physiologic assessment of jailed side branch lesions using fractional flow reserve. J Am Coll Cardiol 2005; 46(4): 633–637.
9. Koo B.-K., Park K.-W., Kang H.J. et al. Physiological evaluation of the provisional side-branch intervention strategy for bifurcation lesions using fractional flow reserve. Eur Heart J 2008; 29(6): 726–732.
10. Koo B.-K., Waseda K., Kang H.J. et al. Anatomic and functional evaluation of bifurcation lesions undergoing percutaneous coronary intervention. Circulation: Cardiovascular Interventions 2010; 3: 113–119.
11. Ivanov V.A., Movsesyants M.Yu., Bobkov Yu.A. et al. Mezdunar Z Interv Kardioangiol — International Journal of Interventional Cardiology 2008; 14: 38–39.
12. Ivanov V.A., Movsesyants M.Yu., Trunin I.V. Izmerenie intrakoronarnogo davleniya. V kn.: Vnutrisosudistye metody issledovaniya v interventsionnoy kardiologii [Intracoronary pressure measurement In: Intravascular techniques in interventional cardiology]. Nauch. red. Ivanov V.A. [Ivanov V.A. (editor)]. Moscow: Medpraktika; 2008; p. 139–172.
13. Lefevre T., Louvard Y., Morice M.C. et al. Stenting of bifurcation lesions: classification, treatments, and results. Catheter Cardiovasc Interv 2000; 49(3): 274–283.
14. Medina A., Surez de Lezo J., Pan M. A new classification of coronary bifurcation lesions. Rev Esp Сardiol 2006; 59(2): 183–184.
15. Escaned J. Pressure wire: technical considerations. Basic principles of fractional flow reserve. In: Intracoronary diagnostic techniques. Alfonso F., Botas J. (editors). McGraw-Hill/Interamericana, Madrid; 2003; р. 337.

Chebotar Е.V., Britvina О.V., Shakhov B.Е. A New Approach to the Assessment of the Results of Endovascular Correction of Coronary Artery Bifurcation. Sovremennye tehnologii v medicine 2012; (2): 45