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Coronary bifurcation lesions are common but difficult to treat. Longitudinal reconstruction images of frequency domain optical coherence tomography (FD–OCT) are accompanied with less motion artifacts than intravascular ultrasound (IVUS) due to faster flame rate and high–speed pull–back system. Using FD–OCT, we tried to identify pre–procedural predictors of side branch (SB) complications after single–stent crossover technique to coronary bifurcation lesions.
Among 45 patients (mean age : 69.9±8.7 y.o) who underwent elective bifurcation coronary stent implantation, 47 lesions with Medina classification of (1,0,0), (0,1,0), (1,1,0) were studied. FD– OCT was performed on the main branch before and after coronary stenting. SB complication was defined as worsening of SB stenosis (>75%). Based on the multiplane longitudinal reconstruction images around branching point derived from cross–sectional FD–OCT images, SB angle, angle of SB carina tip (SBCT–angle), length between proximal branching–point to carina tip (BPCT–length), %area stenosis and plaque distribution at SB junction point were evaluated.
SB complication was observed in 19 lesions (40.4%). SBCT–angle and BPCT–length were significant smaller in lesions with SB complication compared with those without (33.7±19.7 vs. 68.8±33.6 degree, p<0.01; 1.3±0.7 vs. 2.4±0.9, p<0.01, respectively). Lesions with both SBCT–angle <50 degree and BPCT–length <1.4mm showed significantly higher incidence of SB complications than other lesions (90.0% vs, 27.0%, p<0.01). The absence of plaque in SB carina was associated with a higher rate of SB complication compared with the presence of plaque in SB carina (70.0%
Multi–plane longitudinal reconstruction imaging of FD–OCT is useful to identify the anatomical features of coronary bifurcation lesions. Narrow SBCT–angle, short BPCT–length and the absence of plaque in SB carina were the high risk factors for SB complications after bifurcation stenting.
Poster Sessions, Expo North
Saturday, March 09, 2013, 3:45 p.m.–4:30 p.m.
Session Title: Left Main and Bifurcation Intervention
Abstract Category: 46. TCT@ACC–i2: Coronary Intervention, LM/Bifurcations
Presentation Number: 2105–248
- 2013 American College of Cardiology Foundation