Coronary angioplasty of bifurcational lesions without protection of large side branches

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)

Bifuration coronary angioplasty using a new side branch accessible stent

“…From lesion morphology, therefore, the likelihood of loss of the diagonal after initial dilatation of the LAD was high [1][2][3]. The diagonal vessel in both cases subserved a significant area of myocardium and its preservation was, therefore, important.…”

“…1 HD, a 59-year-old woman with a strong family history of ischaemic heart disease and well-controlled hyperlipidaemia, had angina since 1989. In 1991, she underwent an angioplasty to the diagonal branch .…”

“…The risk of side branch loss is higher when the origin of the side branch is diseased [1][2][3]. A stent deployed in the main vessel may accentuate this risk, particularly if the stent is of slotted tube design or has large metallic surface area when expanded [4].…”

Recanalization of an Occluded Major Side Branch after Stenting with Intracoronary Adenosine.

“…Although side branch protection with an extra guide wire has been accomplished, the incidence of SBO is quite high ranging between 12% to 41%. 3,[13][14][15] There is also the risk of on inability to cross the stent struts after the occlusion, as was the case in our patient, or entrapment of the balloon in these struts. Although a variety of techniques have been proposed for protection of the side branch, such as kissing balloons, T-stenting, Y-stenting, and culotte techniques, SBO is still an important problem.…”

Técnica de pull-back para implante de stent em lesões de bifurcação com envolvimento único do óstio do ramo lateral: avaliação dos resultados iniciais e aos seis meses pós-implante

“…O sucesso do implante ocorreu em todos os procedimentos. Foram submetidos a coronariografia tardia 22 (59,5%) pacientes, tendo sido observada reestenose no ramo lateral em nove (40,9%) pacientes e desenvolvimento de lesões > 50% no vaso principal em sete (31,8% 4,5 , ocasionado pela maior concentração de fibras elásticas e musculares ao redor do óstio 6 . Tentativas de solução desse problema com o emprego de laser ou aterectomia rotacional foram desapontadoras 7,8 .…”