ABSTRACT
BACKGROUND: The two main problems unresolved in coronary bifurcation stenting are periprocedural side branch compromise and higher restenosis at long term. The purpose of this study is to reveal the link between periprocedural side branch compromise and long-term results after main vessel stenting only in coronary bifurcations. METHODS: Eighty-four patients formed the study population. The inclusion criteria were good-quality angiograms, with maximal between-branch angle opening, no overlap, permitting accurate angiographic analysis. Carina angle (alpha)-the distal angle between main vessel (MV) before bifurcation and side branch (SB)-was measured pre- and poststenting. Clinical follow-up 9-12 months was obtained with coronary angiography if needed. RESULTS: The patient population was high-risk with 33% diabetics and 84% two- and three-vessel disease. Ninety-five stents were implanted in 92 lesions, with three T-stenting cases. Drug-eluting stents were implanted in 54%. Kissing-balloon (KBI) or sequential inflation was performed in 35%. SB functional closure occurred in 17.4%, with independent predictors alpha < 40 degrees and diameter ratio MB/SB >1.22. After 12+/-4 months there were five myocardial infarctions (6%) and 13 (15%) target lesion revascularization procedures. Independent predictors of major cardiovascular events were carina angle <40 degrees , MB lesion length >8 mm, negative change of between-branch angle, DES usage, and KBI. CONCLUSIONS: Smaller carina angle with straightening of MV-main branch from stent implantation in coronary bifurcations predicted higher SB compromise, restenosis, and MACE rates during follow-up of 1 year.
Subject(s)
Coronary Angiography/methods , Coronary Artery Disease/therapy , Coronary Restenosis/prevention & control , Coronary Vessels/pathology , Drug-Eluting Stents , Aged , Analysis of Variance , Antineoplastic Agents, Phytogenic/therapeutic use , Clopidogrel , Confidence Intervals , Coronary Angiography/instrumentation , Coronary Artery Disease/diagnosis , Coronary Artery Disease/drug therapy , Coronary Restenosis/drug therapy , Coronary Restenosis/mortality , Everolimus , Female , Humans , Image Interpretation, Computer-Assisted/instrumentation , Image Interpretation, Computer-Assisted/methods , Immunosuppressive Agents , Male , Mathematics , Multivariate Analysis , Odds Ratio , Paclitaxel/therapeutic use , Platelet Aggregation Inhibitors/therapeutic use , Poland , Registries , Retrospective Studies , Sirolimus/analogs & derivatives , Sirolimus/therapeutic use , Statistics as Topic , Ticlopidine/analogs & derivatives , Ticlopidine/therapeutic use , Time FactorsABSTRACT
Spinal cord stimulation (SCS) is one of the methods for treating angina pectoris and has been used since 1985. Patients with refractory angina pectoris despite optimal medication and revascularisation procedures are suitable for the SCS. This kind of treatment is not common in Poland. This article reports the first case of a patient with ischaemic heart disease treated with spinal cord stimulation in the Clinical Department of Neurosurgery in the Military Clinical Hospital in Bydgoszcz. The procedure was based on epidural implantation of the electrode at the level of Th1-Th2 and connection with the impulse generator located subcutaneously. As a result of the applied stimulation reduction of the anginal pain was achieved.
