Five-Year Results of Endovascular Treatment of Patients with Left Main Coronary Arteries Bifurcation Lesions

Methods: In group I (n=132) were included patients with true bifurcation lesions and in group II (n=152) – were non-bifurcations (psesudobifurcation). All patients in a ratio of 1:1 were implanted stents with paclitaxel and everolimus. The each groups were additionally randomized into 2 subgroups: subgroup AI, AII (n=66 in each subgroup) - included patients, who underwent 1-stent bifurcation strategy and subgroup BI, BII (n=76 in each subgroup) - who underwent 2-stent strategy (Culotte and Crush/Mini-Crush). Primary endpoints: MACE and restenosis according to digital angiography and IVUS.
Results: in group I and II frequency of MACE were 5.3 and 7.2% respectively (p=0,003). The restenosis in bifurcation area, according digital angiographyin both groups was 6.8 and 9.8% respectively (p=0.0024). TLR in both groups amounted 4.5 and 6.5% respectively (p=0.004). In the subgroup of true bifurcations, with strategy 1S, were significant differences in the change of average residual lumen area of the vessel in comparison with the data obtained after the PCI. The average residual lumen area in the ostia of the LCx decreased from 5,32±0,14 to 4.98 ± 0.12 mm²(p = 0.034), at the ostia of the LAD - from 6.12 ± 0.14 to 5.63 ± 0.2 mm²(p = 0.028). At the patients with 2S strategy, significant differences were not obtained. 142 patients in the study were implanted two stents at the bifurcation. The frequency of MACE in Culotte and Crush/Mini-Crush groups was 2.8 and 8.6% respectively (p<0.001).
Conclusion: Everolimus-eluting stents associated with higher efficacy and safety in bifurcation stenting of left main coronary artery, compared with Paclitaxel-eluting stents. Culotte-technique of LMCA bifurcation stenting shows better long-term results, as compared to Crush/Mini-Crush-technique.