cardiovascularКардиоваскулярная терапия и профилактикаCardiovascular Therapy and Prevention1728-88002619-0125«SILICEA-POLIGRAF» LLC10.15829/1728-8800-2012-6-33-37cardiovascular-1963Research ArticleИШЕМИЧЕСКАЯ БОЛЕЗНЬ СЕРДЦАCORONARY HEART DISEASEКлиническая эффективность реканализации хронических окклюзий коронарных артерий билатеральным способомClinical effectiveness of bilateral recanalization of chronic coronary artery occlusionРузановИ. С.RuzanovI. S.

(контактное лицо) – аспирант

Тел.: 8 (917) 320 57 67, (8452) 20 22 06

cortison24@mail.ruШитиковИ. В.ShitikovI. V.

в.н.с. лаборатории

Тел.: 8 (917) 320 57 67, (8452) 20 22 06

cortison24@mail.ruТитковИ. В.TitkovI. V.

н.с. лаборатории

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cortison24@mail.ruГлуховЕ. А.GlukhovE. A.

аспирант

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cortison24@mail.ruСанбаевА. К.SanbaevA. K.

врач-ординатор

Тел.: 8 (917) 320 57 67, (8452) 20 22 06

cortison24@mail.ruЖуравельМ. С.ZhuravelM. S.

врач-ординатор

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cortison24@mail.ruОлейникА. О.OleynikA. O.

зав. лабораторией инвазивной кардиологии

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cortison24@mail.ruСаратовский НИИ кардиологии Минздравсоцразвития России, СаратовSaratov Research Institute of Cardiology, Saratov2012201220121163337Copyright © Рузанов И.С., Шитиков И.В., Титков И.В., Глухов Е.А., Санбаев А.К., Журавель М.С., Олейник А.О., 20122012Рузанов И.С., Шитиков И.В., Титков И.В., Глухов Е.А., Санбаев А.К., Журавель М.С., Олейник А.О.Ruzanov I.S., Shitikov I.V., Titkov I.V., Glukhov E.A., Sanbaev A.K., Zhuravel M.S., Oleynik A.O.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://cardiovascular.elpub.ru/jour/article/view/1963

Цель. Изучить ангиографическую и клиническую эффективность эндоваскулярной реканализации хронических окклюзий коронарных артерий (ХОКА) билатеральным доступом в непосредственном и отдаленном периодах, сравнительно с тактикой консервативного лечения. Материал и методы. Включены 56 больных ишемической болезнью сердца с ХОКА. Оценивался функциональный класс (ФК) стенокардии, клинически и по данным ЭКГ проб, локальная и глобальная сократимость миокарда по данным эхокардиографии. I группа (гр.) – 36 больных, которым выполнена попытка чрескожной коронарной ангиопластики ХОКА методом билатерального доступа. II гр. – 20 пациентов, оставались на консервативном лечении. Клиническая эффективность лечения оценивалась по результатам наблюдения в течение 12 мес. Результаты. В I гр. изначально у 16 больных III ФК стенокардии, у 20 – II ФК. Из 36 попыток реканализации билатеральным доступом – 27 ангиографически успешны. Все ангиографически успешные процедуры имели непосредственный клинический успех. В отдаленном периоде клинический успех в I гр. отмечен у 20 пациентов. Зарегистрировано повышение глобальной сократимости миокарда с 54±3% до 56,9±4% (р=0,03). Во II гр. изначально III ФК стенокардии у 10 больных, II ФК у 10. В отдаленном периоде стабилизация клинического состояния достигнута у 15 пациентов. Фракция выброса левого желудочка 53,9±2,4% (р=0,9). Полученные осложнения коронарной ангиопластики не приводили к значимым ишемическим и геморрагическим событиям, а клинические показатели были значимо выше сравнительно с консервативной тактикой. Заключение. Реканализации ХОКА билатеральным способом являются технически сложными вмешательствами, сопряженными с повышенным риском осложнений, требующими большого хирургического опыта оперирующего. Применение их оправдано при невозможности антеградного доступа, высоком анестезиологическом риске коронарного шунтирования, отказе пациента от кардиохирургического лечения.

Aim. To assess the short- and long-term angiographic and clinical effectiveness of endovascular bilateral recanalization of chronic coronary artery occlusion (CCAO), compared to conservative therapeutic strategy. Material and methods. The study included 56 patients with coronary heart disease and CCAO. Angina Functional Class (FC) was assessed clinically and in electrocardiography tests. Local and global myocardial contractility was assessed using echocardiography. Group I (n=36) included CCAO patients who underwent an attempt of bilateral percutaneous coronary angioplasty; Group II (n=20) included CCAO patients who were treated conservatively. Clinical effectiveness of the treatment was assessed at 12 months. Results. At baseline, 16 and 20 Group I patients had FC III and II, respectively. Out of 36 attempts of bilateral recanalization, 27 were successful, based on the angiography results. All these 27 cases were also clinically successful in the short term, and 20 in the long term. Global myocardial contractility increased from 54±3% to 56,9±4% (p=0,03). In Group II, 10 and 10 patients had baseline FC III and II, respectively. The long-term stabilisation of clinical status was observed in 15 patients, with the mean levels of left ventricular ejection fraction of 53,9±2,4% (p=0,9). Observed complications of coronary angioplasty did not result in clinically significant ischemic and haemorrhagic events, while the clinical improvement was substantially more pronounced, compared to Group II. Conclusion. Bilateral CCAO recanalization is a technically demanding procedure, requiring an extensive surgical expertise and experience, and linked to a higher risk of complications. However, it could be used when the antegrade access is impossible; the anaesthesiological risk of coronary artery bypass graft surgery is high; and the patient refuses the cardiac surgery intervention.

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The authors declare that there are no conflicts of interest present.