Uvećanje odnosa dijametra glavne grane i veličine stenta povezano je sa smanjenim protokom u bočnoj grani kod “pravih” račvi koronarnih arterija lečenih “provizornom” implantacijom stenta – studija sa dvodimenzionalnom kvantitativnom koronarografijom

  • Ivan Ilić Clinical Hospital Center Zemun, Department of Cardiology, Belgrade, Serbia
  • Radosav Vidaković Clinical Hospital Center Zemun, Department of Cardiology, Belgrade, Serbia
  • Aleksandra Janićijević Clinical Hospital Center Zemun, Department of Cardiology, Belgrade, Serbia
  • Milica Stefanović Clinical Hospital Center Zemun, Department of Cardiology, Belgrade, Serbia
  • Srdjan Kafedžić Clinical Hospital Center Zemun, Department of Cardiology, Belgrade, Serbia
  • Milivoje Cerović Clinical Hospital Center Zemun, Department of Cardiology, Belgrade, Serbia
  • Dušan Milićević Clinical Hospital Center Zemun, Department of Cardiology, Belgrade, Serbia
  • Gojko Obradović Clinical Hospital Center Zemun, Department of Cardiology, Belgrade, Serbia
  • Vladimir Jovanović Clinical Hospital Center Zemun, Department of Cardiology, Belgrade, Serbia
  • Ivan Stanković Clinical Hospital Center Zemun, Department of Cardiology, Belgrade, Serbia
  • Biljana Putniković Clinical Hospital Center Zemun, Department of Cardiology, Belgrade, Serbia
  • Aleksandar N. Nešković Clinical Hospital Center Zemun, Department of Cardiology, Belgrade, Serbia
DOI: https://doi.org/10.2298/VSP171228033I
Ključne reči: perkutana koronarna intervencija, stentovi, krv, cirkulacija, angiografija koronarnih arterija

Sažetak


Uvod/Cilj. Perkutane koronarne intervencije (PKI) lezija na račvi sa suženjem većim od 50% na glavnoj grani (GG) predstavljaju izazov. Procena dijametara i uglova primenom programa kvantitativne koronarografije (KK) korišćena je u proceni ishoda PKI. Istraživali smo potencijalne efekte „provizorne“ implantacije stenta u GG na protok u bočnoj grani (BG) određivanjem kvantitativnih parametara krvnog suda kod „pravih“ račvi koje ne zahvataju glavno stablo leve koronarne arterije, primenom 2D KK programa. Metode. Prospektivna studija, sprovedena u univerzitetskom centru sa velikim brojem PKI, uključila je bolesnike sa „pravim“ račvama nativnih koronarnih arterija (Medina 1.0.1, 0.1.1, 1.1.1) lečene „provizornom“ implantacijom stenta u GG. U studiju nisu bili uključeni bolesnici sa ejekcionom frakcijom (EF) manjom od 30%, klirensom kreatinina manjim od 30 mL/kg/m2 ili lezijom na račvi odgovornoj za infarkt miokarda, hirurški revaskularizovanoj ili prethodno lečenoj primenom PKI. KK analizom mereni su referentni dijametri (RD) GG i BG, stepen dijametar suženja (DS) i uglovi bifurkacija. Rezultati. Studija je uključila 70 bolesnika sa 72 račve. Većina račvi nalazila se u slivu prednje descedentne grane (PDA) – dijagonalna arterija (Dga). Kompromitacija ostijuma BG definisana kao smanjenje koronarnog protoka TIMI < 3 nastala je kod 17/72 (23,6%) račve. Tretirana je angioplastikom ostijuma BG [9/17 (52,9%)] ili implantacijom stenta [8/17 (47,1%)]. U logističkoj regresionoj analizi koja je uključila prethodno poznate prediktore kompromitacije BG (uglovi bifurkacije, RD, DSi odnos GG RD prema dijametru stenta) samo je odnos RD GG prema dijametru stenta bio nezavisni prediktor smanjenje protoka u GG nakon implantacije stenta [OR 2,758 (95% CI 1,298 – 5,862); p = 0,008]. Zaključak. Sniženje koronarnog protoka u bočnoj grani nakon „provizorne“ implantacije stenta u glavnu granu, kod „pravih“ račvi koronarnih arterija, povezano je sa uvećanim odnosom dijametra glavne grane prema dijametru stenta na osnovu dvodimenzionalne KK.

Biografija autora

Ivan Ilić, Clinical Hospital Center Zemun, Department of Cardiology, Belgrade, Serbia

Clinical Hospital Center Zemun

Cardiac catheterization Lab

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Objavljeno
2021/08/19
Broj časopisa
Vol. 77 Br. 1 (2020): Vojnosanitetski pregled
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Originalni članak