Use of provisional stenting technique in bifurcation lesions of coronary arteries: results of a survey of endovascular surgeons

Objective. To analyze the current state of application of the provisional stenting technique for bifurcation lesions of the coronary arteries by different specialists in various medical organizations in Russia. Materials and methods. The data required for analysis and statistical processing were obtained by developing a formalized questionnaire (20 questions, some of which with the ability to select several answers at the same time - multiple choice), which was published in three Russian Internet communities dedicated to endovascular surgery (“Angiopicture”, “Rentgenhirurg Club” and “Endovascular School”). Participation was anonymous. The survey lasted 14 days (from June 23, 2024 to August 6, 2024). The results of the study were collected using the Google Forms online service and processed using the Google Sheets service. Multiple-choice answers were processed as absolute numbers and presented as a percentage of the total number of answers to a specific question. Results and discussion. The total number of respondents who took part in the survey was 86, whose average age was 35 years. Practical activity is represented by work in medical organizations of various levels, but most of the responses were received from 3rd level MO (48.8%). The professional experience of most respondents in the specialty does not exceed 15 years (80.2%). The following results were revealed based on the study: Slightly less than half of the respondents (43%) equally assess the possibility of using provisional stenting on a planned and emergency basis. When choosing this technique, 58.1% of respondents rely on their professional experience in treating bifurcation lesions of the coronary arteries. The vast majority of endovascular surgeons perform sequential insertion of coronary guidewires into the main branch and then into the side branch using two coronary guidewires. (73.3%). When performing provisional stenting, the preferred technique is the classical one, with sequential “POT-kissing-POT” dilations (34.9%). The most common criterion for performing SB dilation after MV stenting is significant impairment of blood flow through the SB (TIMI <3) – 81.4%. When switching to a two-stent technique, surgeons give great preference to the following techniques: “CULLOTE” (75.6%) and “T/TAP” (64%). The reasons for using the provisional stenting technique are: good results in the early and late postoperative periods (82.6%), ease of implementation (83.7%), and the possibility of switching to a two-stent technique (66.3%). Conclusion. To date, there is no unified approach to provisional stenting for bifurcation coronary artery disease. The results of this survey revealed disagreements among specialists regarding the indications and sequence for selecting and performing provisional stenting. Finding the optimal method for performing provisional stenting is a critically important clinical task aimed at reducing perioperative complications and improving long-term treatment outcomes.