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2020, vol. 77, iss. 1, pp. 53-59
The increased main branch to stent diameter ratio is associated with side branch decreased coronary flow in "true" coronary artery bifurcations treated by "provisional" stenting: A two-dimensional quantitative coronary angiography study
aUniversity of Belgrade, Faculty of Medicine, Clinical Center 'Zemun' + University of Belgrade, Faculty of Medicine
bUniversity of Belgrade, Faculty of Medicine, Clinical Center 'Zemun'
Background/Aim. Percutaneous coronary interventions (PCI) in bifurcation lesions having more than 50% stenosis of both the main branch (MB) and the side branch (SB) remain challenging. Measurements of the vessel diameters and angles using quantitative coronary angiography (QCA) software have been used in evaluating PCI outcomes. We investigated potential effects of provisional stenting of the MB on SB coronary blood flow by determining quantitative vessel parameters in "true" non-left main coronary bifurcation lesions using conventional two-dimensional QCA. Methods. The study was prospective and conducted in a high-volume university PCI center. Study included patients with "true" native coronary artery bifurcations (Medina 1.0.1; 0.1.1; 1.1.1) treated with "provisional" stenting of the MB. Patients were excluded from the study if having left ventricular ejection fraction of less than 30%, having renal failure with creatinine clearance below 30 mL/kg/m2 or bifurcation lesions within the culprit artery causing myocardial infarction, grafted surgically or previously treated by PCI. QCA analysis included measurements of reference vessel diameters (RVD), diameter stenosis (DS) and bifurcation angles. Results. The study included 70 patients with 72 "true" non-left main bifurcations. Most of the bifurcations were located in the left anterior descending (LAD) - diagonal (Dg) territory. Compromise of the SB ostium defined as thrombolysis in myocardial infarction (TIMI) < 3 coronary flow occurred in 17/72 (23.6%) bifurcations. It was treated by either balloon angioplasty only of the SB ostium (9/17, 52.9%) or stent implantation [8/17 (47.1%)]. In a logistic regression analysis, including previously recognized predictors of SB compromise (bifurcation's angles, RVD, DS and ratio of MB RVD to stent diameter ratio), only MB RVD to stent diameter ratio after PCI remained independent predictor of SB coronary flow compromise after stent implantation in the MB [OR 2.758 (95% CI 1.298-5.862); p = 0.008]. Conclusions. It appears that SB decreased coronary blood flow after "provisional" stenting in "true" non-left main bifurcations is associated with greater MB to stent diameter ratio.
Colombo, A., Moses, J.W., Morice, M.C., Ludwig, J., Holmes, D.R., Spanos, V., Louvard, Y., Desmedt, B., di Mario, C., Leon, M.B. (2004) Randomized Study to Evaluate Sirolimus-Eluting Stents Implanted at Coronary Bifurcation Lesions. Circulation, 109(10): 1244-1249
Dou, K., Zhang, D., Xu, B., Yang, Y., Yin, D., Qiao, S., et al. (2015) An angiographic tool for risk prediction of side branch occlusion in coronary bifurcation intervention: The RESOLVE score system (Risk prEdiction of Side branch OccLusion in coronary bifurcation interVEntion). JACC Cardiovasc Interv, 8(1): 39-46
Grottum, P., Svindland, A., Wallroe, L. (1983) Localization of atherosclerotic lesions in the bifurcation of the main left coronary artery. Atherosclerosis, 47(1): 55-62
Grundeken, M.J., Ishibashi, Y., Ramcharitar, S., Tuinenburg, J.C., Reiber, J.H.C., Tu, S., Aben, J., Girasis, C., Wykrzykowska, J.J., Onuma, Y., Serruys, P.W. (2015) The need for dedicated bifurcation quantitative coronary angiography (QCA) software algorithms to evaluate bifurcation lesions. EuroIntervention, 11(V): V44-V49
Gwon, H.C., Song, Y.B., Pan, M. (2015) The story of plaque shift and carina shift. EuroIntervention, 11(V): V75-V77
Hahn, J.Y., Chun, W.J., Kim, J.H., Song, Y.B., Oh, J.H., Koo, B.K., et al. (2013) Predictors and outcomes of side branch occlusion after main vessel stenting in coronary bifurcation lesions: Results from the COBIS II Registry (COronary BIfurcation Stenting). J Am Coll Cardiol, 62: 1654-1663
Hildick-Smith, D., Behan, M.W., Lassen, J.F., Chieffo, A., Lefèvre, T., Stankovic, G., et al. (2016) The EBC TWO Study (European Bifurcation Coronary TWO): A Randomized Comparison of Provisional T-Stenting Versus a Systematic 2 Stent Culotte Strategy in Large Caliber True Bifurcations. Circ Cardiovasc Interv, 9(9): 3643-3643
Huo, Y., Finet, G., Lefevre, T., Louvard, Y., Moussa, I., Kassab, G.S. (2012) Which diameter and angle rule provides optimal flow patterns in a coronary bifurcation?. Journal of Biomechanics, 45(7): 1273-1279
Ishibashi, Y., Grundeken, M.J., Nakatani, S., Iqbal, J., Morel, M.A., Généreux, P., Girasis, C., Wentzel, J.J., Garcia-Garcia, H.M., Onuma, Y., Serruys, P.W. (2015) In vitro validation and comparison of different software packages or algorithms for coronary bifurcation analysis using calibrated phantoms: Implications for clinical practice and research of bifurcation stenting. Catheterization and Cardiovascular Interventions, 85(4): 554-563
Kang, S.J., Mintz, G.S., Kim, W.J., Lee, J.Y., Oh, J.H., Park, D.W., et al. (2011) Changes in left main bifurcation geometry after a single-stent crossover technique: An intravascular ultrasound study using direct imaging of both the left anterior descending and the left circumflex coronary arteries before and after intervention. Circ Cardiovasc Interv, 4(4): 355-61
Kini, A.S., Yoshimura, T., Vengrenyuk, Y., Amirian, J., Hasan, C., Baber, U., Narula, J., Sharma, S.K. (2016) Plaque Morphology Predictors of Side Branch Occlusion After Main Vessel Stenting in Coronary Bifurcation Lesions: Optical Coherence Tomography Imaging Study. JACC: Cardiovascular Interventions, 9(8): 862-865
Koo, B.K., Waseda, K., Kang, H.J., Kim, H.S., Nam, C.W., Hur, S.H., Kim, J.S., Choi, D., Jang, Y., Hahn, J., Gwon, H., Yoon, M., Tahk, S., Chung, W., Cho, Y. (2010) Anatomic and Functional Evaluation of Bifurcation Lesions Undergoing Percutaneous Coronary Intervention. Circulation: Cardiovascular Interventions, 3(2): 113-119
Lansky, A., Tuinenburg, J., Costa, M., Maeng, M., Koning, G., Popma, J., Cristea, E., Gavit, L., Costa, R., Rares, A., van Es, G., Lefevre, T., Reiber, H., Louvard, Y., Morice, M. (2009) Quantitative angiographic methods for bifurcation lesions: A consensus statement from the European Bifurcation Group. Catheterization and Cardiovascular Interventions, 73(2): 258-266
Lassen, J.F., Holm, N.R., Banning, A., Burzotta, F., Lefèvre, T., Chieffo, A., Hildick-Smith, D., Louvard, Y., Stankovic, G. (2016) Percutaneous coronary intervention for coronary bifurcation disease: 11th consensus document from the European Bifurcation Club. EuroIntervention, 12(1): 38-46
Medina, A., Suárez, D.L.J., Pan, M. (2006) A New Classification of Coronary Bifurcation Lesions. Revista Española de Cardiología (English Edition), 59(2): 183-183
Medrano-Gracia, P., Ormiston, J., Webster, M., Beier, S., Young, A., Ellis, C., Wang, C., Smedby, Ö., Cowan, B. (2016) A computational atlas of normal coronary artery anatomy. EuroIntervention, 12(7): 845-854
Reiber, J.H. (2011) Introduction to QCA, IVUS and OCT in interventional cardiology. International Journal of Cardiovascular Imaging, 27(2): 153-154
Reiber, J.H., Serruys, P.W., Kooijman, C.J., Wijns, W., Slager, C.J., Gerbrands, J.J., Schuurbiers, J.C., Den, B.A., Hugenholtz, P.G. (1985) Assessment of short-, medium-, and long-term variations in arterial dimensions from computer-assisted quantitation of coronary cineangiograms. Circulation, 71(2): 280-288
Routledge, H.C., Lefèvre, T., Colombo, A., Oldroyd, K.G., Hamm, C.W., Guagliumi, G., von Scheidt, W., Guetta, V., Ruzyllo, W., Wittebols, K., Goedhart, D., Serruys, P. (2009) Three-year clinical outcome of percutaneous treatment of bifurcation lesions in multivessel coronary artery disease with the sirolimus-eluting stent: Insights from the Arterial Revascularisation Therapies Study, part II (ARTS II). EuroIntervention, 5(2): 190-196
Sakamoto, N., Hoshino, Y., Mizukami, H., Sugimoto, K., Yamaki, T., Kunii, H., Nakazato, K., Suzuki, H., Saitoh, S., Takeishi, Y. (2016) Intravascular ultrasound predictors of acute side branch occlusion in coronary artery bifurcation lesions just after single stent crossover. Catheterization and Cardiovascular Interventions, 87(2): 243-250
Stone, P.H., Saito, S., Takahashi, S., Makita, Y., Nakamura, S., Kawasaki, T., Takahashi, A., Katsuki, T., Nakamura, S., Namiki, A., Hirohata, A., Matsumura, T., Yamazaki, S., Yokoi, H., Tanaka, S. (2012) Prediction of progression of coronary artery disease and clinical outcomes using vascular profiling of endothelial shear stress and arterial plaque characteristics: The PREDICTION Study. Circulation, 126(2): 172-181
Suárez, D.L.J., Medina, A., Martín, P., Novoa, J., Suárez, D.L.J., Pan, M., Caballero, E., Melián, F., Mazuelos, F., Quevedo, V. (2012) Predictors of ostial side branch damage during provisional stenting of coronary bifurcation lesions not involving the side branch origin: An ultrasonographic study. EuroIntervention, 7(10): 1147-1154
Xu, J., Hahn, J.Y., Song, Y.B., Choi, S.H., Choi, J.H., Lu, C., et al. (2012) Carina shift versus plaque shift for aggravation of sidebranch ostial stenosis in bifurcation lesions: Volumetric intravascular ultrasound analysis of both branches. Circ Cardiovasc Interv, 5(5): 657-62


article language: English
document type: Original Scientific Paper
DOI: 10.2298/VSP171228033I
published in SCIndeks: 08/02/2020
peer review method: double-blind
Creative Commons License 4.0

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