الفهرس 
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Abstract
Approximately 20% of percutaneous coronary interventions (PCIs) are performed to treat coronary bifurcations. Significant left main (LM) coronary artery disease is found in 4.8% of patients undergoing coronary angiography. Despite the recent developments that have been made in the field of percutaneous left main intervention, the treatment of distal LM bifurcation remains challenging. Technical success was defined as the ability to cross the occluded segment with both a wire and balloon and successfully open the artery with a <10% residual stenosis in all views. Procedural success was defined as a technical success with no in-hospital major adverse cardiac event (MACE), A MACE was defined as the occurrence of death, no reflow or STEMI. This study aimed to assess the procedural and clinical outcomes in LM bifurcational intervention. This controlled study was carried out between October 2019 and July 2021, in Tanta university Hospitals, cardiology department. 100 patients eligible to Left Main bifurcational intervention were included in our study. In this study, the patients were divided into two groups according to the stenting technique used, provisional group (n=70),those patients managed with the provisional strategy and non-provisional group(n=30),those patients managed with one of the two stents strategies either double kissing crush, cullote, T stenting or TAP technique according to the decision of our team. This study recorded the incidence of major adverse cardiac events (MACE): non-fatal MI, death or target lesion revascularizations at 6 and12 Months of follow-up. This study found that there is no statistically difference in mortality incidence between the two groups but non-fatal myocardial infarction, stent thrombosis and target lesion revascularizations were significantly increased in the non-provisional group. One patient in provisional group (1.4%) and 3 patients in non-provisional group (10%) had re-infarction at 12 months. There was significant increase in the incidence of re-infarction at 6 months in the non-provisional group (P= 0.029) and the same at 12 months. Two patients in provisional group about (2.9%) and 5 patients (16.7%) in non-provisional group had TLR at 12 month (P= 0.013) indicating that non-provisional group had significant increase in the incidence of TLR than provisional group. As regard clinical success in provisional and non-provisional groups, this study found 68 patients in provisional group (97.1%) and 24 patients (80%) in non-provisional group has fulfilled the characters of clinical success The study concluded that there was no significant difference in mortality incidence between provisional and non-provisional groups but there was significant increase of non-fatal myocardial infarction, stent thrombosis and target lesion revascularizations in the non-provisional strategy and so the clinical outcome is better in the provisional than the non-provisional strategies.