Radiomorphological changes of the coronary artery in patients with coronary artery disease with recurrent angina in the first year after angioplasty and stenting of multi-vessel lesions

• Main Authors: E. B. Molokhoev, B. A. Rudenko, A. S. Shanoyan, O. M. Drapkina
• Format: Article
• Language: Russian
• Published: «SILICEA-POLIGRAF» LLC 2019-11-01
• Series: Кардиоваскулярная терапия и профилактика
• Subjects: iatrogenic lesions of the intima of the coronary artery; angioplasty and stenting; recurrence of angina, progression of atherosclerosis
• Online Access: https://cardiovascular.elpub.ru/jour/article/view/2299
• ISSN: 1728-8800; 2619-0125

Aim. To study the radiomorphological changes in coronary arteries (CA) and their contribution to the recurrence of angina pectoris in patients in the first year after angioplasty and stenting of multi-vessel lesions of CA; to identify factors contributing to the progression of atherosclerosis in poorly modified segments of CA after percutaneous coronary intervention (PCI). Material and methods. The study included 102 patients. Multivariate analysis with assessment of clinical risk factors, radiomorphology of the CA before and after PCI, analysis of the technique of the operation to identify factors contributing to the progression of atherosclerosis in the slightly altered segments of CA.Results. Restenosis of the coronary arteries was observed in 43 cases when the stent was implanted BMS (bare-metal stent). Diabetes mellitus, hypertension, dyslipidemia, chronic heart failure, obesity, smoking did not affect the development of restenosis. Hypertension increased the risk of progression of atherosclerosis in the source hemodynamically insignificant stenosis of the right coronary artery (RCA) and left circumflex artery (LCX), peripheral atherosclerosis was associated with progression of atherosclerosis of the left anterior descending artery (LAD). The diabetes mellitus, obesity, smoking did not significantly affect the progression of atherosclerosis in the proximal segments. Performing techniques of “deep intubation” of guide catheters to the left coronary artery (LCA) led to the progression of stenosis growth in the proximal segments of permanent residence. The use of more than one wire and angulation of LCX divergence of more than 90 degrees significantly leads to the progression of atherosclerosis in the proximal segments of LCX. Performing pre-dilatation of proximal segments without subsequent stent coating led to the development of stenosis in LAD, RCA and LCX. Extended calcined lesions are associated with the progression of atherosclerosis in the proximal segments. The use of an extension cord catheter did not affect the progression of atherosclerosis in the proximal segments.Conclusion. Along with stent restenosis, provoking factors of the “iatrogenic” process in the proximal segments may be a combination of aggressive manipulations during PCI, the complexity of the radiomorphology of coronary arteries. The analysis of the use of new endovascular less traumatic technologies (the use of an extension cord catheter) reduces the risk of “iatrogenic” damage to the intima and the progression of atherosclerosis.