Stenting of coronary bifurcation lesions: case series.

AIM: To assess the procedural success and major cardiac event rate after stenting of coronary bifurcation lesions.

METHODS

The prospective study included 36 patients with coronary artery bifurcation lesion treated with stenting between January 1999 and December 2001 at the Institute for Heart Disease, Skopje University Center. There were 23 men and 13 women, with a mean age of 62.5+/-12.3 years. Seventeen patients had acute myocardial infarction and 19 patients had unstable angina. The follow-up lasted 6 months. The strategy of systematic coronary stenting in the bifurcation lesions involving a side branch of >2.2 mm in diameter was prospectively evaluated according to the quantitative coronary angiography (QCA) measurements. Procedural success was defined as a residual stenosis of less than 20%. Major cardiac events included deaths, emergency coronary artery bypass grafting (CABG), Q-wave myocardial infarction, acute and subacute closure, repeated percutaneous transluminal coronary angioplasty (PTCA), and non-Q myocardial infarction.

RESULTS

Out of a total of 36 bifurcation lesions, the left anterior descending/diagonal bifurcation lesion was found in 22 patients, circumflex/marginal in 8 patients, posterior descending artery/posterolateral artery in 4 patients, and left main coronary artery in 2 patients. The main branch of the coronary artery (mean+/-SD reference diameter, or the diameter of the normal coronary artery, 2.90+/-0.36 mm) was stented in 35 patients and the side branch of the main coronary artery (2.35+/-0.42 mm reference diameter) in 24 patients. The major cardiac events occured in 3 patients: one had Q-wave myocardial infarction, one developed acute and subacute closure, and one underwent PTCA. There were no deaths or emergency CABG.

CONCLUSION

The development of new surgical strategies and stent design has improved the safety and immediate outcome of bifurcation stenting, but procedural success still needs to be matched by an equal clinical improvement and long-term patency.