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Coronary angioplasty of bifurcational lesions without protection of large side branches
R Ciampricotti1, M el Gamal, B van Gelder
1Department of Cardiology, Catharina Hospital, Eindhoven, The Netherlands.
Insights
Percutaneous coronary intervention (PCI) of major branches is safe without side branch (SB) protection, showing low complication rates. This approach leads to favorable long-term outcomes in patients with coronary artery disease.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Medicine
Background:
- Side branch (SB) occlusion is a potential complication during percutaneous coronary intervention (PCI) of major branches (MB).
- Assessing the risk and clinical relevance of SB occlusion without protective measures is crucial for procedural safety and patient outcomes.
Purpose of the Study:
- To evaluate the incidence and clinical significance of SB occlusion during MB PCI performed without SB protection.
- To determine the safety and long-term efficacy of this strategy in patients with coronary artery disease.
Main Methods:
- A prospective study involving 67 patients undergoing MB PCI without protection of large SBs (≥1.8 mm).
- Detailed assessment of SB stenosis severity (ostial and non-ostial) and procedural outcomes, including SB occlusion, recanalization rates, and myocardial infarction.
- Follow-up included clinical assessment, exercise testing, and angiography to evaluate restenosis and long-term outcomes.
Main Results:
- MB PCI was successful in 66 out of 67 patients.
- Occlusion occurred in 10 SBs (14.5%), with 5 being asymptomatic.
- Successful recanalization was achieved in 4 out of 5 symptomatic SB occlusions.
- At a mean follow-up of 2.2 years, 89% of patients were asymptomatic with favorable angiographic results.
Conclusions:
- Percutaneous coronary intervention of bifurcational lesions can be effectively performed without SB protection.
- This strategy is associated with a low rate of complications and favorable long-term clinical and angiographic outcomes.
- SB occlusion during MB PCI without protection is manageable and does not significantly compromise patient outcomes.
Abstract:
To assess the risk and clinical relevance of side branch (SB) occlusion during angioplasty (PTCA) we attempted PTCA of major branches (MB) without protection of lesion-associated large (> or = 1.8 mm) SBs in 67 patients (50 men). There were 32 patients with unstable angina and 35 with stable angina. Their mean age was 55 years (range 31-77). There were 69 SBs: 43 with severe ostium stenosis (type A); 6 with severe non ostial stenosis (type B); and 20 with no or slight nonostial stenosis (type C). PTCA of the MB was successful in all but one patient who underwent acute bypass surgery. After MB PTCA occlusion occurred in 10 SBs (7A, 1B, 2C) and was asymptomatic in 5. Recanalization and dilatation was successful in 4 out of 5 symptomatic SB occlusions. A single patient developed a non-q wave myocardial infarction. PTCA was also attempted in 21 diseased SBs and failed in one. 21 SBs remained severely stenotic and 6 occluded. During follow-up symptomatic MB restenosis occurred in 12 patients, associated with restenosis in 4 out of 6 dilated SBs. Four patients underwent bypass surgery and 8 repeat successful PTCA. The SB was redilated in 2 cases and occluded silently in one. Angiography in 16 asymptomatic patients showed moderate MB restenosis in 3 and SB occlusion in 2. At 2.2 years follow-up 60 (89%) patients were asymptomatic with a normal exercise test and/or maintained angiographic result. Angioplasty of bifurcational lesions without SB protection can be effectively performed with a low rate of complications and a favourable long-term outcome.(ABSTRACT TRUNCATED AT 250 WORDS)