Visual estimation versus different quantitative coronary angiography methods to assess lesion severity in bifurcation lesions

Abstract

Our study showed that bifurcation lesion complexity was significantly affected when more advanced bifurcation QCA software were used. "True" bifurcation lesion rate was 100% on visual estimation, but as low as 13% when analyzed with dedicated bifurcation QCA software.

Bifurcation lesion assessment with advanced quantitative coronary angiography: A method still wanting

“…Grundeken et al's data are consistent with the large body of work demonstrating that simple QCA only marginally improves the predictive value of visual assessment including bifurcations. If 2D and 3D bifurcation QCA is eventually validated by FFR in larger studies, (which seems supremely challenging, especially given anatomical/functional mismatch of the varying myocardial bed sizes), then it may be helpful for operators where bifurcation FFR will not or cannot be performed.…”

“…A limitation of the study by Grundeken et al was the lack of a true anatomic or more importantly functional standard for a bifurcation lesion. As a result, although the number of significant appearing lesions became less severe with more intense QCA methodology, there is no validation with FFR assessment to determine whether 3D QCA reduced false‐positives, or increased false‐negatives.…”

“…In this issue of Catheterization and Cardiovascular Interventions , Grundeken et al report their experience with bifurcation QCA software (Cardialysis using Pie Medical Imaging and CFR using QAngio XA, Medis Medical Imaging Systems) in patients with bifurcation lesions (defined as >50% narrowing in two branches by visual estimate) enrolled in a bifurcation stent trial. In 113 lesions, visual estimation, single‐vessel QCA, 2D bifurcation QCA, and 3D bifurcation QCA were compared to evaluate how each classified bifurcation lesion severity and extent of disease.…”

Comparison of transradial coronary intervention for left main bifurcation disease using the new Braidin® slender 7 Fr sheath and a standard 6 Fr sheath

“…The Medina classification method was used for description of lesion classification in this study. 6 The total kissing balloon diameter was defined as the sum of the diameters of kissing balloons during the operation of the two-stent technology. The proximal optimization technique was defined as use of a short balloon with a larger diameter to dilate the proximal main branch of the bifurcation lesion.…”

Contemporary Cardiac MRI in Chronic Coronary Artery Disease

“…been well covered elsewhere. 6,[12][13][14] The results of the Clinical Outcomes Utilizing Revascularization And Aggressive Drug Evaluation (COURAGE) trial indicated that revascularisation did not reduce the risk of major cardiovascular and cerebral adverse events (MACCE) in stable patients. 15 The Fractional Flow Reserve Versus Angiography For Multivessel Evaluation (FAME) trials highlighted the need for an objective measurement of the significance of high-grade stenoses in terms of their functional relevance prior to intervention.…”