Clinical Study Of Different Strategies Of Ostial Left Anterior Descending Lesions Guided By Intravascular Ultrasound

BackgroundThe ostial lesions in the left anterior descending（LAD）coronary artery can lead to massive myocardial ischemia or myocardial infarction.These consequences increase the mortality rate of patients.The interventional treatment of this kind of lesion is still the focus of clinical research and the difficulty of interventional treatment.There are different strategies of single stent techniques.The application of endovascular imaging reduces the incidence of stent failure after interventional therapy for such lesions,and improves the prognosis of these patients.Not only there are few studies on interventional therapy guided by endovascular imaging in domestic and foreign clinical studies and meta analyses,but also there are few researchs in comparing the advantages and disadvantages of different interventional therapies on this kind of lesion.Therefore,more clinical studies are needed to do to guide the selection of interventional therapies and bring better outcomes for these patients.ObjectiveThis study compared the prognostic observations of the three kind of single-stent techniques:precise positioning technique,floating technique and crossover technique in the interventional treatment of such lesions under the guidance of intravascular ultrasound.The purpose of this study is to compare the efficacy and safety of the three interventional methods,to guide the choice of interventional methods of the ostial lesions in the left anterior descending coronary artery,to improve the prognosis of patients and to evaluate the clinical value of intravascular ultrasound（IVUS）in guiding the interventional strategies.MethodsAccording to strict inclusion and exclusion criteria,patients admitted to the Cardiology Department of Zhengzhou Seventh People’s Hospital from October 2018 to March 2021 were screened out by CAG diagnosis of the ostial lesions in the LAD.IVUS was used to evaluate the lesions and stent implantation before and after interventional techniques.Retrospective cases were divided into 3 groups: group A was treated with single stent precise localization technique,group B with single stent floating technique,and group C with single stent crossover technique.This study evaluated the safety and effectiveness by observing the perioperative and postoperative complications and analyzed endpoint events such as all-cause death,sudden cardiac death,target vessels reascularization,stent restenosis and stent thrombosis.Using statistical analysis method,this study compared the outcomes of three IVUS-guided single stent interventions for this disease to evaluate their clinical outcomes.ResultsThe data of 94 patients（25 in the precise positioning group,33 in the floating group and 36 in the crossover group）were analyzed.There were no significant differences in baseline data（including general condition and basic medical history）and coronary angiography related indexes（P > 0.05）.In IVUS imaging indicators,there were statistically significant differences in the plaque load at the stent edge and the affected rate of the side branch in IVUS imaging indicators（P < 0.05）.The crossover group had a better reduction of geographical loss than the precise positioning group on the plaque load at the stent edge.The floating group can reduce the risk of side branch effects better than the crossover group.Recurrence of angina pectoris was statistically significant in the end point event（P < 0.05）,the risk of recurrent angina was decreased in the floating group compared with the crossover group,and the risk of recurrent angina was decreased in the crossover group compared with the precise positioning group（P<0.05）.There is no significant effect on other endpoint events,but it needs further confirmation with larger sample size studies.Conclusions（1）In the single stent interventional treatment of the ostial lesions in the LAD guided by IVUS,the floating group was superior to the crossover group,and the crossover group was superior to the precise localization.（2）The three intervention methods are effective and safe;IVUS has important clinical value in single stent interventional treatment of the ostial lesions in the LAD.