Abstract
Introduction: The aim of this investigation is to evaluate the possibilities of the method of cardiography from the coronary sinus (ECG-CS) in optimization of stenting bifurcation lesions (BL) of coronary arteries (CA). Materials and Methods: 43 patients with stable CHD with pseudo-BL of the anterior descending artery (ADA) were included in this investigation. We placed a 10-canal electrode into their coronary sinus at the beginning of percutaneous coronary intervention (PCI). Ischemic guidance was done with the WorkMate electrophysiological recording system. Results: In 11 patients (25%) out of 43 with CHD, the diagonal branch (DB) comprometation and ischemia dynamics (p<0.05) in intracardiac lead (CS 3-4) after ADA stenting were discovered according to ECG-CS. Nine patients (20.9%) underwent successful provisional-T-stenting, while a second stent was required for the other 2 patients. Conclusion: ECG-CS provides the possibility to optimize coronary intervention in the area of CA bifurcation.
Highlights
The aim of this investigation is to evaluate the possibilities of the method of cardiography from the coronary sinus (ECG-CS) in optimization of stenting bifurcation lesions (BL) of coronary arteries (CA)
All the diagonal branches in the BL area are important from the standpoint of hemodynamics: the diameter of the DB ostium is 2.46 ± 0.23 mm
It is necessary to acknowledge angiography’s limitations, which often result in an underestimation of the stenosis, while on the other hand, we should keep in mind the dissection risk and a successive and necessary transition to percutaneous coronary intervention (PCI) with double-stenting, which increases the risk of SB restenosis in the future [7, 10,12]
Summary
The aim of this investigation is to evaluate the possibilities of the method of cardiography from the coronary sinus (ECG-CS) in optimization of stenting bifurcation lesions (BL) of coronary arteries (CA). The most notable shortcoming of the existing methods of bifurcation stenting is an extensive local “metallization” of a stented artery due to applying one stent to another, in addition to the disturbance of the safety of the polymerdrug layer of stents during operations. These current flaws are often the reasons for restenosis developing and that of arterial bifurcation thrombosis as well, reducing the clinical efficiency of bifurcation stenting in the future [12]. In the case of optimal results, the dilatation of both branches with the help of kissing angioplasty (provisional T-stenting) is typically used, whereas double stenting methods are used mainly in patients with unsatisfactory clinical angiographical results of the provisional T-stenting (D, F-type dissection, considerable angious pain with negative dynamics of the ECG, bloodstream < TIMI III on the side branch (SB) [7, 10, 12]
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