[Angioplasty at the bifurcation of the anterior interventricular artery and diagonal artery].
The IVA/diagonal coronary bifurcation is a high risk area for atheromatous disease. Major technical and strategic risks make the treatment of these lesions a real "challenge" for the interventional cardiologist: angioplasty-stenting and surgery are in direct competition.


OBJECTIVE
the aim of this study was to determine the significance of interventional techniques in treating the IVA/diagonal bifurcation, drawing on the experiences of a cardiological haemodynamic laboratory and comparing these results with those obtained with the reference technique, represented by aorto-coronary bypass with the internal mammary artery.


METHODS
this was a monocentric retrospective study of a series of 133 patients treated with angioplasty-stenting between January 1997 and December 2002 for a new IVA/Dg bifurcation lesion. Patients admitted for myocardial infarction were excluded.


RESULTS
no matter which angioplasty revascularisation technique was used, the angiographic success rate was 95% with 3% occlusions of the diagonal artery. At six months, 72% of patients were asymptomatic, the rate of treated lesion revascularisation (TLR) was 21.9%. At one year 68.8% of patients were asymptomatic, and the TLR was 24.2%. The technique evolved during the six years, especially with the expansion of the radial approach and increasingly frequent use of the "kissing balloon"; at one year the TLR and the rate of major cardiac events was 31% in 1997 and 15% in 2002.


CONCLUSIONS
angioplasty-stenting in this at-risk region is thus favourable, and gives results comparable with those of internal mammary/IVA bypass, save on the TLR. However, the development of stents "pre-formed" for the bifurcation and especially "active" endoprostheses could represent a solution to the delicate problem of restenosis.
Barbey
C
C
Laboratoire d'hemodynamique et de cardiologie interventionnelle, hôpital Trousseau, CHU de Tours, 37044 Tours. Barbey_c@med.univ-tours.fr
Desveaux
B
B
Quilliet
L
L
de Labriolle
A
A
Magdelaine
B
B
Krsticevic
L
L
Pacouret
G
G
Charbonnier
B
B
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000379:methods*; D001161:Arteriosclerosis / Q000517:prevention & control; D017023:Coronary Angiography; D003331:Coronary Vessels / Q000601:surgery*; D005260:Female; D006352:Heart Ventricles; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents; D016896:Treatment Outcome