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Stenting of coronary bifurcation lesions: case series
Vladimir Kotevski1, Hristo Pejkov
1Institute for Heart Diseases, Skopje University Hospital Center, Medical Faculty, St Cyril and Methodius University, Skopje, Republic of Macedonia. v_kotevski@hotmail.com
Insights
Coronary bifurcation stenting showed improved safety and immediate outcomes in a 36-patient study. While procedural success was high, long-term clinical improvement and patency require further enhancement.
Area of Science:
- Interventional Cardiology
- Cardiovascular Surgery
Background:
- Coronary artery bifurcation lesions pose unique challenges for stenting.
- Previous strategies had limitations in achieving optimal outcomes.
Purpose of the Study:
- To evaluate the procedural success and major adverse cardiac event (MACE) rates following stenting of coronary bifurcation lesions.
- To assess the safety and efficacy of a systematic stenting strategy for these complex lesions.
Main Methods:
- Prospective study of 36 patients with coronary bifurcation lesions undergoing stenting (Jan 1999-Dec 2001).
- Systematic stenting strategy applied to lesions with side branches >2.2 mm.
- Quantitative coronary angiography (QCA) used for evaluation.
- Follow-up duration of 6 months.
Main Results:
- Procedural success (residual stenosis <20%) was achieved in the majority of cases.
- Major cardiac events occurred in 3 patients (1 Q-wave MI, 1 acute/subacute closure, 1 PTCA).
- No deaths or emergency coronary artery bypass grafting (CABG) were reported.
Conclusions:
- Newer surgical strategies and stent designs have enhanced the safety and immediate results of bifurcation stenting.
- While procedural success is promising, achieving comparable long-term clinical improvement and sustained patency remains an area for development.
Aim:
To assess the procedural success and major cardiac event rate after stenting of coronary bifurcation lesions.
Methods:
The prospective study included 36 patients with coronary artery bifurcation lesion treated with stenting between January 1999 and December 2001 at the Institute for Heart Disease, Skopje University Center. There were 23 men and 13 women, with a mean age of 62.5+/-12.3 years. Seventeen patients had acute myocardial infarction and 19 patients had unstable angina. The follow-up lasted 6 months. The strategy of systematic coronary stenting in the bifurcation lesions involving a side branch of >2.2 mm in diameter was prospectively evaluated according to the quantitative coronary angiography (QCA) measurements. Procedural success was defined as a residual stenosis of less than 20%. Major cardiac events included deaths, emergency coronary artery bypass grafting (CABG), Q-wave myocardial infarction, acute and subacute closure, repeated percutaneous transluminal coronary angioplasty (PTCA), and non-Q myocardial infarction.
Results:
Out of a total of 36 bifurcation lesions, the left anterior descending/diagonal bifurcation lesion was found in 22 patients, circumflex/marginal in 8 patients, posterior descending artery/posterolateral artery in 4 patients, and left main coronary artery in 2 patients. The main branch of the coronary artery (mean+/-SD reference diameter, or the diameter of the normal coronary artery, 2.90+/-0.36 mm) was stented in 35 patients and the side branch of the main coronary artery (2.35+/-0.42 mm reference diameter) in 24 patients. The major cardiac events occured in 3 patients: one had Q-wave myocardial infarction, one developed acute and subacute closure, and one underwent PTCA. There were no deaths or emergency CABG.
Conclusion:
The development of new surgical strategies and stent design has improved the safety and immediate outcome of bifurcation stenting, but procedural success still needs to be matched by an equal clinical improvement and long-term patency.
