pirogovestnikВестник Национального медико-хирургического центра им. Н.И. ПироговаBulletin of Pirogov National Medical & Surgical Center2072-82552782-3628Национальный медико-хирургический Центр им. Н.И. Пирогова10.25881/20728255_2025_20_3_21pirogovestnik-353Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИORIGINAL ARTICLESПРИМЕНЕНИЕ ТЕХНИКИ PROVISIONAL-СТЕНТИРОВАНИЯ ПРИ БИФУРКАЦИОННОМ ПОРАЖЕНИИ КОРОНАРНЫХ АРТЕРИЙ: РЕЗУЛЬТАТЫ ОПРОСА РЕНТГЕНЭНДОВАСКУЛЯРНЫХ ХИРУРГОВUSE OF PROVISIONAL STENTING TECHNIQUE IN BIFURCATION LESIONS OF CORONARY ARTERIES: RESULTS OF A SURVEY OF ENDOVASCULAR SURGEONSБазуновА. К.BazunovA. K.

Санкт-Петербург

Saint Petersburg

bazunovak@yandex.ruБирюковА. В.BiryukovA. V.

Санкт-Петербург

Saint Petersburg

ПелипасьА. Ю.Pelipas’A. Yu.

Санкт-Петербург

Saint Petersburg

ШевченкоК. Э.ShevchenkoK. E.

Санкт-Петербург

Saint Petersburg

ХубулаваГ. Г.KhubulavaG. G.

Санкт-Петербург

Saint Petersburg

ФГБОУ ВО «Первый Санкт-Петербургский государственный медицинский университет им. академика И.П. Павлова»РоссияPavlov UniversityRussian Federation2025290820252032128Copyright © Базунов А.К., Бирюков А.В., Пелипась А.Ю., Шевченко К.Э., Хубулава Г.Г., 20252025Базунов А.К., Бирюков А.В., Пелипась А.Ю., Шевченко К.Э., Хубулава Г.Г.Bazunov A.K., Biryukov A.V., Pelipas’ A.Y., Shevchenko K.E., Khubulava G.G.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://submit.pirogov-vestnik.ru/jour/article/view/353

Цель исследования. Проанализировать опыт применения методики provisional-стентирования при бифуркационных поражениях коронарных артерий разными специалистами в различных медицинских организациях России.Материалы и методы. Необходимые для анализа и статистической обработки данные получены путем разработки формализованного опросного листа (20 вопросов, часть из которых с возможностью выбора нескольких ответов одновременно – множественный выбор), который был опубликован в трех Российских интернет-сообществах, посвященных эндоваскулярной хирургии (“Angiopicture”, “Rentgenhirurg Club” и “Endovascular School”). Участие было анонимным. Длительность анкетирования составила 14 дней (с 23 июня 2024 г. по 6 августа 2024 г.) Результаты исследования собраны с помощью онлайн-сервиса “Google Формы” и обработаны с использованием сервиса “Google Таблицы”. Ответы с множественным выбором обработаны в виде абсолютных чисел и представлены в процентном соотношении от общего числа ответов на конкретный вопрос.Результаты и обсуждение. Общее число респондентов, принявших участие в опросе, составило 86, средний возраст которых составил 35 лет. Практическая деятельность представлена работой в медицинских организациях разного уровня, однако большая часть ответов получена из МО 3-его уровня (48,8%). Профессиональный стаж большинства респондентов по специальности не превышает 15 лет (80,2%). По итогам исследования выявлены следующие результаты: чуть меньше половины опрошенных (43%) равно оценивают возможность использования провизорного стентирования в плановом и экстренном порядках. Выбирая данную технику, 58,1% респондентов опираются на свой профессиональный опыт лечения бифуркационных поражений коронарных артерий. Значительное большинство эндоваскулярных хирургов выполняют последовательное заведение коронарных проводников в основную ветвь, а затем в боковую, используя два коронарных проводника (73,3%). При выполнении Provisional-стентирования, предпочтительной методикой является классическая, с выполнением последовательных “POT-kissing-POT” дилатаций (34,9%). Самым частым критерием для выполнения дилатации БВ после стентирования ОВ является значимое нарушение кровотока по БВ (TIMI <3) – 81,4%. При выполнении перехода на двухстентовую методику большие предпочтения хирурги отдаются техникам: “CULLOTE” (75,6%) и “T/TAP” (64%). Причинами использования методики provisional-стентирования являются: хорошие результаты в раннем и отдаленном послеоперационных периодах (82,6%), простота выполнения (83,7%), возможность перехода на двухстентовую методику (66,3%).Заключение. На сегодняшний день отсутствует единый подход к выполнению provisional-стентирования при бифуркационном поражении коронарных артерий. Результаты данного опроса выявили разногласия среди специалистов относительно показаний и последовательности выбора и выполнения provisional-стентирования. Поиск оптимального метода выполнения provisional-стентирования является критически важной клинической задачей, направленной на снижение периоперационных осложнений и улучшение отдаленных результатов лечения.

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.

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