Optimization of coronary bifurcation angioplasty by intravascular ultrasound

Introduction: Transluminal Coronary Angioplasty (PTCA) with drug-eluting stents (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 well known Objective: To assess the effectiveness of PTCA with DES optimized by intracoronary ultrasound (IVUS) in coronary bifurcation and combined events of death, myocardial infarction (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: The patients were followed on average 324 +/- 83 days. The mean age was 61.4 +/- 18.3 years; male gender 82%, diabetes 27%; multivessel disease 88%; calcified lesion 13.6% in angiography and 27% by IVUS. Syntax Score <22 in 69.1%, 23-32 in 27.3%. The most frequent bifurcation was anterior descending-diagonal 53.5%. Implanted patients with provisional stent technique 78.5%. DES mean luminal area was 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 pts with subclinical infarction (2.4%). Follow-up: 1 pt with 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 procedure, with a low incidence of major in-hospital and late complications. An optimal implantation of the stent has impact on the results of the procedure.