Despite the modern optimal drug therapy and various surgical methods, coronary artery disease is currently one of the most significant problems of medicine. The risk of recurrent myocardial ischemia increases in long-term period after coronary artery bypass surgery, especially in patients with diffuse coronary lesions. The main factors of such results are progression of atherosclerosis and dysfunction of coronary artery grafts. Repeated myocardial revascularization through percutaneous coronary intervention is the safest and optimal option. However, there is currently no unambiguous and generally accepted opinion about endovascular treatment of such patients with diffuse coronary lesions.
OBJECTIVE
To estimate the efficacy and safety of endovascular correction of coronary artery and bypass graft lesions in patients with coronary artery disease, diffuse coronary artery lesions and myocardial ischemia recurrence after coronary artery bypass surgery.
MATERIAL AND METHODS
The study included 106 patients with recurrent myocardial ischemia after coronary artery bypass surgery who underwent treatment in 2013—2020. Coronary artery stenting was performed in the 1st group (55 (51.9%) patients), and graft stenting was carried out in the 2nd group (51 (48.1%) patients). Clinical and angiographic characteristics were similar. The endpoints were mortality, restenosis after endovascular correction, myocardial infarction and MACE after 1 and 12 months.
RESULTS
In the 1st group, lesion length and number of implanted stents were significantly greater: 25.7 [20.9; 31.6] and 18.8 [17.2; 22.1] mm p=0.023; 121 and 71 stents, respectively. Transradial access was more common in the 1st group (24 (43.6%) and 9 (17.6%), respectively, p=0.004). In long–term period, mortality and restenosis rate were slightly higher in the 2nd group (4 (7.3%) and 6 (11.8%) deaths, p=0.434; 7 (10.8%) and 9 (16.7%) cases of restenosis, respectively, p=0.352). The MACE rate was similar (11 (20.0%) and 15 (29.4%) cases, respectively, p=0.265).
CONCLUSION. S
Tenting of native coronary arteries in patients with coronary artery disease, diffuse coronary lesions and recurrent myocardial ischemia after coronary artery bypass surgery demonstrates a tendency to better results within 1 and 12 months regarding restenosis, myocardial infarction rate and mortality compared to stenting of coronary artery bypass grafts.
