Вплив результатів внутрішньосудинного дослідження на безпосередній результат стентування основного стовбура лівої коронарної артерії

Abstract

The purpose of the study is to optimize the immediate results of stenting of the main trunk of the left coronary artery (LCA) in patients with coronary heart disease (CHD) using intravascular imaging methods and modern technological approaches.Materials and methods. We present the experience of 186 consecutive patients with coronary artery disease in whom stenting of the Left Main (LM) coronary artery was performed.Results. Patients were divided into 2 groups – group I, «historical» (100 patients), where the intervention was performed without the use of intravascular imaging methods and proximal optimization methods (POT), and group II, which consisted of 86 patients in whom LM stenting was performed using intravascular imaging and modern methods of optimizing the stented segment. In general, groups I and II were comparable. About 20 % of patients had an isolated LM lesion. In other cases, according to the results of coronary angiography, multivessel lesions of the coronary vessels were recorded in the patients. The localization of the lesion was defined as ostial in 7.5 %, stem – 6.9 %, and distal with the involvement of LAD&CX in 85.6 %. Stenting with 1 stent was used in 132 patients (71 % of cases).Analyzing the final size of the stented LM segment in the groups, we noticed, that in group I, this figure was 3.41±0.41 mm, while in group II it was 3.97±0.61 mm (p<0.0001). In 3 patients of group I in 30 day period cardiac death were recorded, in the group II there were 2 (2.3 %) cases of LM dissection treated with additional stent implantation.In 3 patients (3 %) group I sudden cardiac death was registered in the 30-day period. In group II, there were 2 (2.3 %) cases of ossification, which were resolved by additional stent implantation.Conclusions. Intravascular imaging to assess the size and results of the intervention, as well as the use of the POT technique, significantly improves the positioning of the stent in the artery and provides a significantly larger diameter of the stented LM. Adequate optimization of the size of the stented LM can be obtained only with the help of intravascular imaging methods.