A New Approach to the Assessment of the Results of Endovascular Correction of Coronary Artery Bifurcation

The aim of the investigation is to study the results of endovascular treatment of patients with coronary bifurcation disorders performed under the control of selective coronography and intravascular manometry, and to assess on the basis of their analysis the manometric findings of blood flow in bifurcation branches when choosing endovascular correction management. Materials and Methods. The analysis of peculiarities and the results of endovascular correction of coronary bifurcations was performed in 67 patients with test T-stenting. The bifurcation state of the 1 st group patients (n=32) was assessed by contrast angiography and the measurement of fractional flow reserve, the patients of the 2 nd group (n=35) — by angiography findings only. Long-term results (follow-up period is 12 months) were studied in 30 patients (93.8%) of the 1 st group, and in 33 patients (94.3%) of the 2 nd group. Results. In 11 of 32 cases angiographic assessment of stenosis in the lateral branch mouth was different from that of manometric one. There was determined an average degree of correlation (R=0.46; р=0.008). In Y-type bifurcation there was no correlation between the assessments of hemodynamic significance of stenosis in the lateral branch (R=0.21; р=0.464). In a follow-up period, angina recurrence or the increase of its degree was revealed in 3 patients (10.0%) of the 1 st group, and in 11 patients (33.3%) of the 2 nd one (р=0.035). Restenoses in lateral branches were found in 2 patients (6.7%) of the group under study and in 10 patients (30.3%) in the control group (р=0.024).Conclusion. The use of complex approach to the assessment of the results of coronary bifurcation correction improves the results of surgeries due to the decrease of restenoses rate and the necessity of re-revascularization in the follow-up. The advantage of the approach is more accurate assessment of hemodynamic changes in bifurcation branches and, therefore, the possibility to choose an optimal technique of endovascular correction.