Noninvasive and invasive diagnostics and percutaneous treatment of bifurcation lesions

Project is comprised by several substudies with the following aims: 1) to evaluate in multicenter study morphologic characteristics of atherosclerotic plaque at bifurcation level by noninvasive and invasive methods and quantify local haemodynamic parameters in order to investigate mechanism of plaque development and identify vulnerable plaques. Biomarkers of inflammation and pro-inflammatory mediators will be assessed and DNA polymorphism and tissue expression of proatherogenic and atheroprotective genes will be correlated with imaging results; 2) to correlate anatomic and functional significance of bifurcation lesion, especially at the ostium of the side branch (SB); 3) to evaluate the impact of bifurcation angle assessed by 3D-QCA on clinical outcome; 4) in patients treated with provisional SB stenting evaluate the impact of jailed wires, routine SB predilatation and finall kissing balloon inflation on procedural success and clinical outcome of the patients; 5) in randomized trial investigate clinical outcomes following simple versus complex stenting strategies for the treatment of large true bifurcations with significant length (>5mm) of ostial SB disease (T/TAP vs. Culotte). Expected results: to verify the importance of local haemodynamic factors for focal development of atherosclerosis; confirm that low shear-stress and morphological plaque characteristics can predict high-risk plaques; suggest optimal approach for simple and complex bifurcation stenting strategies.