Author + information
- Tatsuhiro Fujimura1,
- Takayuki Okamura2,
- Jyutaro Yamada3,
- Tetsuro Oda4,
- Mamoru Mochizuki5,
- Hiroki Tateishi6,
- Shigehiko Nishimura7,
- Abdul Mozid8 and
- Masafumi Yano9
- 1Athens Heart Center, Athens Medical Center, Ube, Japan
- 2Unknown, Rotterdam, Netherlands
- 3Department of Cardiology, Hospital of the Sisters of Charity Linz
- 4Bristol Royal Infirmary
- 5Division of Cardiology, Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine, Ube, Japan
- 6Bristol Royal Infirmary
- 7Bristol Heart Institute
- 8Bristol Heart Institute
- 9Hospital Universitario de Guadalajara
In bifurcation stenting, three-dimensional Optical Coherence Tomography (3D-OCT) enables the assessment of jailing stent configurations at side branch (SB) ostia. Previous studies demonstrated that distal guide wire recrossing and favorable stent positioning were important to reduce the incidence of incomplete stent apposition (ISA) at SB ostia after kissing balloon dilatation (KBD). However, their impact on the fate of treated SB ostia has not been fully understood. We aimed to investigate the impact of jailing configuration and recrossing point before KBD on the side branch ostial area (SBA) at follow up.
Thirty-four patients who underwent the single crossover stenting with KBD for bifurcation lesion under OCT guidance were enrolled. Follow-up OCT images were obtained at 9 months post-procedure. Jailing strut configuration and the recrossing point were assessed visually by 3D-OCT. The jailing configuration was classified according to the existence of the longitudinal stent link adjacent to carina (link-positive or no-link). Incidence of ISA at SB ostium immediately after the procedure (BL;baseline) was counted. SBA was measured by a cut-plane analysis using validated software (MEDIS QAngioOCT) at BL and follow-up (FU). Serial change ratio of side branch ostial area (ΔSBA ratio) was calculated by means of the following formula; (BL SBA-FU SBA)/BL SBA. Cases were divided into 2 groups as follows. Group A was defined as the cases in which both distal rewiring and no-link configuration were achieved (n=18), whereas group B was defined as all others (n=16). Parameters were compared between the 2 groups.
There was a significant difference in ISA at SB ostium between group A and B (0.019 ± 0.028 % vs 0.119 ± 0.099 %, p<0.01). Incidences of target lesion vascularization and in-stent restenosis were no different, while ΔSBA ratio of group A was significantly smaller than that of group B (-0.15±0.34 vs 0.14±0.24, p <0.01).
This serial OCT study suggests that achievement of no-link configuration and distal recrossing reduced ISA at SB ostium after KBD and preserved the side branch ostial area until 9 month follow up.