Reasons and frequency of transition to a double-stent technique when correcting bifurcation lesions of the coronary arteries in patients with acute coronary syndrome

The objective was to estimate the risk and predictors of intraoperative transition from a single-stent technique of correction of bifurcation lesions of the coronary arteries to a double-stent technique.

METHODS AND MATHERIALS. The study included 49 patients (35 men – 71.4 % and 14 women – 28.6 %) with acute coronary syndrome, whose coronary angiography revealed non-stem bifurcation lesions of the coronary arteries. The patients were operated with single- (Provisional) and double- (Culotte and TAR) stent techniques. Three patients had two bifurcation lesions at once. Thus, 52 bifurcations were included in the study. The average age of patients was 62±8 years. The lateral branch was affected in 34.6 % of cases. A blood clot in the bifurcation area was visualized in 15.4 % of cases. The study is a prospective analytical one. Statistical data processing was carried out using the chi-square test. The statistically significant value was considered p<0.05.

RESULTS. In Y-type bifurcation, kissing dilation was performed in 50% of cases, and stent implantation into the lateral branch - in 23.8% of cases (47.6% of cases where kissing dilation was performed). In T-type bifurcation, kissing dilation was required in 33.3% of cases, and the transition to double-stent technique was required in 11.1% of cases (33.3% of cases where kissing dilation was performed (p=0.610)). With the initially affected lateral branch, kissing dilation was required in 88.2 % of cases, and stenting of the lateral branch was required in 47.1 % of cases (53.3% of cases where kissing dilation was performed). With an intact lateral branch, kissing dilation was required in 26.5 % of cases, the second stent was needed in 8.8 % of cases (33.3% of cases where kissing dilation was performed (p<0.001)). In the presence of a blood clot in the bifurcation area, the need for kissing dilation appeared in 75% of cases, and the need for double-stent technique – in 12.5% of cases (20% of cases where kissing dilation was performed).

CONCLUSIONS. When using the Provisional techniques, the kissing dilation was required in 47.1 % of cases. Expansion of the scope of surgical intervention to double-stent technique was required in 21.6 % of cases.

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