To demonstrate that percutaneous coronary intervention (PCI) may in some cases be a safe option for patients with a high-risk surgical category, we report a complex clinical case of revascularization of multivessel coronary artery disease including left main coronary artery (LMCA) quadrifurcation. Methods For safety reasons, PCI was done in 2 separate sessions (staged PCI). Stenting of the LMCA quadrifurcation was performed using different stenting techniques in combination: modified balloon mini crush stenting technique was used - for LMCA and intermediate artery (IMA) stenting; modified balloon crush stenting technique was used for LMCA, circumflex artery (CX) and first obtuse marginal branch (OM1) stenting; provisional stenting technique was used for CX stenting, followed by sequential kissing balloon post-dilatation technique between LMCA and every branch; proximal optimization technique (POT) was performed in the LMCA. Left anterior descending artery (LAD), intermediate artery, circumflex artery, first obtuse marginal branch, left main coronary artery and its quadrifurcation were stented with 5 drug-eluting stents (DES) (Resolute Integrity, Medtronic); right coronary artery (RCA) was stented with 3 bare-metal stents (BMS) (Rebel, Boston Scientific). Results The interventions ended without complications, the ejection fraction increased from 35% to 48%, congestive heart failure functional class decreased to class I. Subsequent coronary angiography, eight months after the last PCI, revealed patent stents with mild, nonsignificant restenosis. More than three years after the intervention, the patient has no complaints (according to MACE). Conclusions It should be considered that in case of the selection of suitable patients and the use of the appropriate revascularization technique, LMCA quadrifurcation lesion can be successfully treated with PCI.

Objective: Search of pathogenetic mechanisms and risk factors of atherosclerosis in the employees of the cleaning service in Tbilisi. Materials and Methods:As a result of a preliminary survey and examination of 200 employes of Tbilisi cleaning service aged 25-45 years (2014-2016), 22 patients with angina, hypercholesterolemia, intimae-media thickness > 0.65 mm, were selected into I group, and 23 individuals without these disorders into II group. In the blood plasma of the selected patients the intensity of oxidative metabolism parameters, TAA and MDA were determined. The variance and correlation analysis (АNOVA) was used for conducting the comparative analysis of the levels of studied parameters. Results:In the combined group (I+II) there are several reliable correlations between the Age -TCol, Age-MDA, BMI-Tg, BMI-MDA, LDLChol-HDLChol, LDLChol-TChol, HDLChol-TChol, LDLChol-MDA, LDLChol-TAA. no correlation between these parameters in individual groups (I and II) was found. That indicates that we have an imaginary correlation related to the large intergroup difference between the average values of the group indicators, that is the values of various indicators change during the development of the pathological process, but there is no causal relationship between these alterations.The reliable TAA-MDA correlation in the combined group (I+II) is related to the high anticorrelation between these parameters and the significantly higher average value of TAA in the low-risk group (II) in comparison to the high-risk group (I). Conclusion:The results analysis indicates both the diagnostic value of redox status indicators and their leading role in the atherogenesis processes. In populations with a high risk of atherosclerosis, monitoring of serum TAA is recommended.

Chronic total occlusion (CTO) of the left main coronary artery (LMCA) is rare on the angiograms; Coronary Artery Bypass Grafting is the standard method of its revascularization. To demonstrate that PCI may in some cases be a safe option for patients with a high-risk surgical category, we report a complex clinical case of revascularization of chronic total occlusion of the LMCA, left anterior descending artery (LAD), and circumflex artery (CX). Methods Recanalization of the occluded LMCA and LAD was performed by utilizing the support-balloon technique, and CTO wires (Miracle 3™ wire, Abbott Vascular; Runthrough® NS Intermediate wire, Terumo); LAD, CX, LMCA, and its bifurcation, were stented with 3 drug-eluting stents (Resolute Integrity DES, Medtronic); the "Culotte Stenting " technique was used for bifurcation stenting, followed by "Kissing Balloon" post-dilatation technique; proximal optimization technique was performed in the LMCA. Results The intervention ended without complications. 2 months after stenting, the ejection fraction increased from 20% to 38%, improved almost all parameters of the heart, Congestive Heart Failure functional class decreased to class I. Conclusions It should be considered that LMCA CTO lesions can be successfully revascularized with PCI in case of the selection of the suitable patient and appropriate revascularization technique.