Optimization of coronary bifurcation angioplasty by intravascular ultrasound

Abstract

Introduction: Transluminal Coronary Angioplasty (PTCA) with DES of coronary bifurcation lesions continues to be complex, with significant revascularization rates due to restenosis; however it is a feasible option. The limitation of angiography on the anatomical and morphological elements of bifurcations, which have already shown prognostic value, is known. Objective: To assess the efectiveness of IVUS optimized DES implantation in coronary bifurcation and combined events of death, AMI, stroke or revascularization of treated lesions (RTL). Methods: Retrospective, single-center, single-arm registry. From 11/2018 to 10/2021 457 coronary angioplasties were performed of which 84 consecutive patients with coronary bifurcation lesions underwent PTCA with IVUS-guided DES implantation. Results: Follow-up on average 324 ± 83 days. Mean age 61.4 ± 18.3 years; male 82%, diabetes 27%. Multi-vessel disease 88%. Calcified lesion 13.6% in angiography and 27% by IVUS. Syntax Score <22 in 69.1%, 23-32 in 27.3%. Bifurcation anterior descending-diagonal 53.5%. Implanted with provisional stent 78.5%. DES mean luminal area 7.3 mm2 in the main vessel. Re-intervention with a balloon due to hypoexpansion and/or lack of wall apposition 22.6%. In-hospital evolution: 2 p sub-clinical infarction (2.4%). Follow-up: 1 p AMI secondary to stent thrombosis (1.2%) in revascularized lateral vessel. In-hospital and long-term mortality and stroke 0%. Two stents (1.9%) presented late thrombosis, implanted in the lateral vessel, without clinical event. Conclusions: PTCA with DES optimized by IVUS guidance in coronary bifurcation lesions is a safe, with a low incidence of major in-hospital and late complications. An optimal implantation of the stent has impact on results procedure.