Clinical use of various endovascular stenting techniques in challenging coronary interventions

Cover Page


Aim. Development of an algorithm of actions for stenting of artery stenosis during challenging percutaneous coronary interventions (PCI) based on the analysis of the results of different endovascular techniques.

Methods. We analyzed the experience of the department of radiologic endovascular diagnosis and treatment of Stavropol regional clinical hospital for endovascular surgical treatment of atherosclerosis of coronary arteries. The study included 317 cases of coronary interventions with technically impossible stent delivery to stenosis by standard method along the front-line guidewire and standard choice of the guide in case of distal TIMI 3 flow. For the study the patients were divided into 3 groups comparable by the number of subjects: 104, 113 and 100 respectively. For each group we determined different stages of enhancing support with consistent step-wise transition. The groups differed by the used methods of enhancing support and consistency of their use. Among other methods of support group 2 included the method of guide change and delivery of the second guidewire of enhanced support. At the same time groups 1 and 3 used these methods separately.

Results. The smallest number of unsuccessful interventions was observed in group 2 compared to those of groups 1 and 3. The relative risk indicators also demonstrate the high effectiveness of tactics used in the group 2.

Conclusion. The most preferable method for the necessary support when stent delivery distal to stenosis is impossible, is a choice of optimal guide and use of the second guidewire of enhanced support.

G V Sazanov

Stavropol State Medical University; Stavropol Regional Clinical Hospital

Author for correspondence.
Stavropol, Russia; Stavropol, Russia

O S Belokon'

Stavropol State Medical University; Stavropol Regional Clinical Hospital

Stavropol, Russia; Stavropol, Russia

N V Pisarenko

Stavropol Regional Clinical Hospital

Stavropol, Russia

A Yu Krasnov

Stavropol Regional Clinical Hospital

Stavropol, Russia

  • Rentgenendovasku­lyarnaya khirurgiya. Natsionalʹnoe rukovodstvo: v 4 tt. Pod red. аkad. RAN B.G. Alekyana. M.: Litterra, 2017, Vol. 2: 399–426. (In Russ.)
  • Yip H.K., Chen M.C., Chang H.W., et al. Angiographic morphologic features of infarct-related arteries and timely reperfusion in acute myocardial infarction: predictors of slow-flow and no-reflow phenomenon. Chest. 2002; 122 (4): 1322–1332. doi: 10.1378/chest.122.4.1322.
  • Ellis S.G., Ajluni S., Arnold A.Z., et al. Increased coronary perforation in the new device era. Incidence, classification, management, and outcome. Circulation. 1994; 90 (6): 2725–2730. doi: 10.1161/01.CIR.90.6.2725.
  • Cohen B.M., Weber V.J. Blum R.R., et al. Cocktail attenuation of rotational ablation flow effects (CARAFE) study: pilot. Cathet. Cardiovasc. Diagn. 1996; Suppl. 3: 69–72. PMID: 8874932.
  • Hanna G.P., Yhip P., Fujise K., et al. Intracoronary adenosine administered during rotational atherectomy of complex lesions in native coronary arteries reduces the incidence of no-reflow phenomenon. Cathet. Cardiovasc. Interv. 1999; 48 (3): 275–278. doi: 10.1002/(SICI)1522-726X(199911)48:3<275::AID-CCD8>3.0.CO;2-M.
  • Metody statisticheskoy obrabotki meditsinskikh dannykh: мetodicheskie rekomendatsii dlya ordinatorov i aspirantov meditsinskikh uchebnykh zavedeniy, nauchnykh rabotnikov. Sost.: A.G. Kochetov, O.V. Lyang., V.P. Masenko, I.V. Zhirov, S.N. Nakonechnikov, S.N. Tereshchenko. M.: RKNPK, 2012; 42. (In Russ.)
  • Lang T.A. Opisanie statistiki v meditsine. Rukovodstvo dlya avtorov, redaktorov i retsenzentov. Sost. T.A. Lang, M. Sesik. M.: Prakticheskaya meditsina. 2011; 477. (In Russ.)
  • Chen L., Cheng Y., Yang Y., et al. A simple practical balloon anchoring technique within the guide cathe­ter for chronic total occlusion (CTO) of the coronary artery. J. Biomed. Res. 2015; 29 (5): 423–425. doi: 10.7555/JBR.29.20150068.
  • Stathopoulos I., Jimenez M., Panagopoulos G., et al. The decline in PCI complication rate: 2003–2006 versus 19992002. HJC. 2009; 50: 379–387. PMID: 19767279.
  • Alekyan B.G., Buziashvili Yu.I., Golukhova E.Z., Nikitina T.G. i dr. Bolʹshie kardialʹnye oslozhneniya pri chreskozhnykh koronarnykh vmeshatelʹstvakh — prediktory, prichiny razvitiya, metody profilaktiki i algoritmy lechebnykh meropriyatiy. Kreativnaya kardio­logiya. 2011; 1: 28–40. (In Russ.)
  • Montalescot G., Sechtem U., Achenbach S., et al. 2013 ESC Guidelines on the management of stable coro­nary artery disease: the Task Force on the management of stable coronary artery disease of the European Society of Cardiology. Eur. Heart J. 2013; 34: 2949–3003. doi: 10.1093/eurheartj/eht296.
  • Windecker S., Kolh P., Alfonso F., et al. 2014 ESC/EACTS Guidelines on myocardial revascularization: the task force on myocardial revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS) developed with the special contribution of the European Association of Percutaneous Cardiovascular Interventions (EAPCI). Eur. Heart J. 2014; 35: 2541–2619. doi: 10.1093/eurheartj/ehu278.


Abstract - 10

PDF (Russian) - 11


© 2018 Sazanov G.V., Belokon' O.S., Pisarenko N.V., Krasnov A.Y.

Creative Commons License

This work is licensed
under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

Свидетельство о регистрации СМИ ЭЛ № ФС 77-70434 от 20 июля 2017 года выдано Федеральной службой по надзору в сфере связи, информационных технологий и массовых коммуникаций (Роскомнадзор)