CLINICAL EVALUATION OF THE RESULTS OF DELAYED STENTING OF THE OCCLUDED CORONARY ARTERY

The aim is to evaluate the possibility of optimizing the conditions for stent implantation due to remodeling of the occluded coronary artery under the influence of hemodynamic factors of restored antegrade flow. Materials and methods. Recanalization and stenting of chronic coronary artery occlusion were performed in two stages (Group 1) or simultaneously (Group 2). Group 1 consisted of 36 patients, Group 2 – 50 patients. Time interval between the intervention stages in Group 1 was on an average 68 days (from 18 to 176 days). Groups did not differ by age, sex or clinical status of the patients. Repeated surveys were carried out in the following terms: 1 month, 6 and 12, 24 and 36 months after PCI. 
Results. At recanalization stage in Group 1, the difference of artery diameters at the proximal and distal ends of the occlusion zone exceeded the diameter of the distal segment and was 1.78 mm. In Group 2, the value was 0.53 ± 0.7 mm. At the second stage in Group 1, the difference of diameters of the proximal and distal segments decreased to 0.45 ± 0.26 mm by reducing the proximal and increasing the distal sizes of the artery. Remodeling of the coronary artery in Group 1 allowed performing adequate stent implantation at the second stage of intervention (in two months) in 34 cases. Two patients developed recanalized artery reocclusion in 43 and 176 days after the first stage. The clinical effect of recanalization of coronary arteries in both groups did not differ. Manifestations of angina decreased in both groups. According to the 36-month follow-up period not even one case of target lesion intervention was registered in both groups. Conclusion: Remodeling of coronary artery under the influence of blood flow factors observed within several weeks after recanalization, creates favorable conditions for the stent implantation. The method of delayed stenting for complicated forms of chronic occlusions when determining post-recanalization obliteration of the distal coronary bed is safe and acceptable since it allows obtaining an optimal clinical outcome. 

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