Coronary Artery Disease Clinical Trial
Official title:
Predictors and Outcomes of Occlusion of Jailed Side Branches Following Main Vessel Coronary Artery Stenting
Assessment of possible predictors of occlusion of jailed side branches following main vessel coronary artery stenting and detection of clinical, electrocardiographic and echocardiographic changes following occlusion of jailed side branches postprocedural and at 3 months follow-up.
Coronary bifurcation lesion (CBL) involves coronary artery stenosis adjacent to and/or
including the origin of a significant side branch (SB) 1. Treatment of bifurcation lesions
constitute about 15% of coronary interventions and are consequently of major clinical
interest 2. Even in the modern era of per-cutaneous coronary intervention(PCI) with stent
implantation, treatment of bifurcations is hampered by a higher event rate and requires
longer procedure time, more radiation exposure, and higher volumes of contrast material
compared with non-bifurcation lesions 3 .
Occlusion of large side branches (SBs) may result in significant adverse clinical events 4.
Occlusion of jailed sizable septal and right ventricular (RV) side branches (non-classic
bifurcations) is often overlooked following left anterior descending (LAD) and right coronary
artery (RCA) main vessel stenting, respectively. Most of the operators decline intervening in
these side branches on contrary to classic bifurcations as diagonals and obtuse marginal
branches, for example. Whether or not intervening with these occluded jailed side branches
have clinical implications or even sub clinical left ventricular (LV) dysfunction was not
previously elucidated and warrants studying.
Left ventricular function is an important predictor of outcome in patients with coronary
artery disease (CAD). Extensive myocardial ischemia can cause decreased LV contractility and
function 5. Conventional echocardiography enables us to identify significant left ventricular
dysfunction but not sub-clinical dysfunction [10]. Two-dimensional speckle tracking
echocardiography (2D-STE) allows for an angle-independent evaluation of myocardial strain,
and provides comprehensive information on LV myocardial contractility. Thus, 2DSTE is
superior in detecting subtle deterioration of contractility 6 .
In this study, investigators tried to explore the possible predictors and outcomes following
occlusion of jailed side branches after main vessel coronary artery stenting, in both classic
and non-classic bifurcations, and whether intervening via various techniques would have
clinical benefit.
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