Сравнение результатов эндоваскулярной коррекции поражений коронарных артерий и шунтов у пациентов с ишемической болезнью сердца и рецидивом ишемии после хирургической реваскуляризации миокарда

Gleb  Borshchev; Dmitry  Ermakov; Anastasia  Vakhrameeva; Daniil  Ulbashev

doi:10.17116/Cardiobulletin20252002120

Borshchev Gleb 1 St. George Thoracic and Cardiovascular Surgery Clinic of the Pirogov National Medical Surgical Center https://orcid.org/0000-0002-8332-7521
Ermakov Dmitry St. George Thoracic and Cardiovascular Surgery Clinic of the Pirogov National Medical Surgical Center https://orcid.org/0000-0002-8479-8405
Vakhrameeva Anastasia St. George Thoracic and Cardiovascular Surgery Clinic of the Pirogov National Medical Surgical Center https://orcid.org/0000-0003-2429-3015
Ulbashev Daniil St. George Thoracic and Cardiovascular Surgery Clinic of the Pirogov National Medical Surgical Center https://orcid.org/0000-0003-3288-8414

DOI: https://doi.org/10.17116/Cardiobulletin20252002120

Keywords: coronary artery disease, diffuse lesion, repeated myocardial revascularization, endovascular treatment

Abstract

Despite the modern optimal drug therapy and various surgical methods, coronary artery disease is currently one of the most significant problems of medicine. The risk of recurrent myocardial ischemia increases in long-term period after coronary artery bypass surgery, especially in patients with diffuse coronary lesions. The main factors of such results are progression of atherosclerosis and dysfunction of coronary artery grafts. Repeated myocardial revascularization through percutaneous coronary intervention
is the safest and optimal option. However, there is currently no unambiguous and generally accepted opinion about endovascular treatment of such patients with diffuse coronary lesions.
Objective. To estimate the efficacy and safety of endovascular correction of coronary artery and bypass graft lesions in patients with
coronary artery disease, diffuse coronary artery lesions and myocardial ischemia recurrence after coronary artery bypass surgery.
Material and methods. The study included 106 patients with recurrent myocardial ischemia after coronary artery bypass surgery
who underwent treatment in 2013—2020. Coronary artery stenting was performed in the 1st group (55 (51.9%) patients), and graft
stenting was carried out in the 2nd group (51 (48.1%) patients). Clinical and angiographic characteristics were similar. The endpoints were mortality, restenosis after endovascular correction, myocardial infarction and MACE after 1 and 12 months.
Results. In the 1st group, lesion length and number of implanted stents were significantly greater: 25.7 [20.9; 31.6] and 18.8 [17.2;
22.1] mm p=0.023; 121 and 71 stents, respectively. Transradial access was more common in the 1st group (24 (43.6%)
and 9 (17.6%), respectively, p=0.004). In long–term period, mortality and restenosis rate were slightly higher in the 2nd group
(4 (7.3%) and 6 (11.8%) deaths, p=0,434; 7 (10.8%) and 9 (16.7%) cases of restenosis, respectively, p=0.352). The MACE rate
was similar (11 (20.0%) and 15 (29.4%) cases, respectively, p=0.265).
Conclusion. Stenting of native coronary arteries in patients with coronary artery disease, diffuse coronary lesions and recurrent
myocardial ischemia after coronary artery bypass surgery demonstrates a tendency to better results within 1 and 12 months regarding restenosis, myocardial infarction rate and mortality compared to stenting of coronary artery bypass grafts.

Author Biographies

Borshchev Gleb , 1 St. George Thoracic and Cardiovascular Surgery Clinic of the Pirogov National Medical Surgical Center

Graduated with honors in 2007. Stavropol State Medical Academy, specialty "Medical science"; In 2008, he completed a clinical internship at the Stavropol State Medical Academy, specializing in Surgery; In 2010, he completed his clinical residency IU of the Pirogov National Research Medical Center of the Ministry of Health of the Russian Federation, specializing in Cardiovascular Surgery; In 2016, he defended his thesis for the degree of Candidate of Medical Sciences on the topic: "Isolated bypass surgery of the anterior interventricular artery without artificial circulation in patients with high surgical risk"; In 2019, he defended his thesis for the degree of Doctor of Medical Sciences on the topic: "Complex myocardial revascularization with stimulation of extracardial angiogenesis in patients with coronary artery disease with diffuse coronary artery disease"; In 2021, he received the title of associate professor.; In 2024, he became a corresponding member of the Russian Academy of Natural Sciences (RAS); In 2025, he received the title of professor. Work experience: From 2007 to 2008, he was a leading specialist in the Interregional Organization Society for Pharmacoeconomic Research.; From September 2010 to October 2024, he was a hospital cardiovascular surgeon. Pirogov National Research Medical Center of the Ministry of Health of the Russian Federation; From 2014 to 2018, he was an assistant at the Department of Thoracic and Cardiovascular Surgery at the Pirogov National Research Medical Center of the Ministry of Health of the Russian Federation.; From October 2018-2021 - Associate Professor of the Department of Thoracic and Cardiovascular Surgery at the Pirogov National Research Medical Center, Ministry of Health of the Russian Federation; From 2020 to 2021 – Vice-rector of the Institute of Advanced Medical Training Pirogov National Medical and Surgical Center of the Ministry of Health of the Russian Federation; From September 2021 to October 2024, Rector of the Institute of Advanced Medical Training Pirogov National Medical and Surgical Center of the Ministry of Health of the Russian Federation; From October 2021 to June 2024, he was a professor at the Department of Thoracic and Cardiovascular Surgery of the Pirogov National Research Medical Center of the Ministry of Health of the Russian Federation.; From June 2024 to October 2024, he was the Head of the Department of Thoracic and Cardiovascular Surgery at the Pirogov National Research Medical Center of the Ministry of Health of the Russian Federation.; Since October 2024 – present - Head of the training center of GBUZ MMCC Kommunarka DZM.

Ermakov Dmitry , St. George Thoracic and Cardiovascular Surgery Clinic of the Pirogov National Medical Surgical Center

Department of X-ray Surgical Methods of Diagnosis and Treatment, Ph.D. Higher medical education, Federal State Autonomous Educational Institution of Higher Education I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), diploma from 2017, specialty "Medical practice", qualification "Doctor". Clinical residency, IU of the Pirogov National Research Medical Center of the Ministry of Health of the Russian Federation, 2017-2019, specialty "Cardiovascular Surgery". Professional retraining, IU of the Pirogov National Research Medical Center of the Ministry of Health of the Russian Federation, 2019, specialty "X-ray Endovascular diagnostics and treatment". Postgraduate course, IU of the Pirogov National Research Medical Center of the Ministry of Health of the Russian Federation, 2020, specialty "Cardiovascular Surgery", scientific supervisor - Academician of the Russian Academy of Sciences Shevchenko Yu.L. Dissertation defense for the degree of Candidate of Medical Sciences, Pirogov National Research Medical Center, Ministry of Health of the Russian Federation, 2020 Advanced training, IU of the Pirogov National Research Medical Center of the Ministry of Health of the Russian Federation, 04/06/2024, specialty "Cardiovascular Surgery". Author and co-author of more than 20 scientific articles and abstracts. He is the author of an educational and methodological manual, co-author of a monograph on invasive electrocardiography and myocardial ischemia. Member of the Association of Cardiovascular Surgeons of Russia (ASSX), the Russian Scientific Society of Interventional Cardioangiologists (RNOIC), the Russian and European Society of Vascular Surgeons (ROAIS, ESVS). Participant of leading international and All-Russian conferences. General medical work experience since 2015 The main directions of medical work: Interventional cardiology: coronary artery stenting in stable angina pectoris, acute coronary syndrome, occlusive and bifurcation lesions of the coronary bed; correction of intravenous restenosis; Intravascular imaging during coronary interventions: IVUS, optical coherence tomography; Endovascular treatment of atherosclerosis of peripheral arteries, including brachiocephalic arteries, lower extremity arteries, visceral branches; Minimally invasive treatment of patients with chronic venous diseases: balloon angioplasty and stenting for postthrombotic disease, May-Turner syndrome, Nutcracker syndrome, Paget-Schroeter syndrome, etc. Field of scientific interests: Minimally invasive treatment of structural heart diseases: aortic valve replacement, treatment of congenital heart defects in adults; Endovascular and hybrid treatment of thoracic and abdominal aortic pathology; Embolization using various materials, approaches and techniques for bleeding, benign and malignant neoplasms; Percutaneous transhepatic drainage of bile ducts; Neurointervention: embolization of intracranial arteriovenous malformations, intracranial artery aneurysms, assistance with cerebral infarction and intracranial hemorrhage.

Vakhrameeva Anastasia , St. George Thoracic and Cardiovascular Surgery Clinic of the Pirogov National Medical Surgical Center

Department of Radionuclide and Functional Diagnostics, Ph.D.

Ulbashev Daniil , St. George Thoracic and Cardiovascular Surgery Clinic of the Pirogov National Medical Surgical Center

Department of X-ray Surgical Methods of Diagnosis and Treatment, Ph.D.

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Endovascular correction of lesions of coronary arteries and coronary artery bypass grafts in patients with coronary artery disease with recurrent ischemia after surgical myocardial revascularization

Abstract

Author Biographies

References