Clinical use of various endovascular stenting techniques in challenging coronary interventions

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.