Anatomic and Functional Evaluation of Bifurcation Lesions Undergoing Percutaneous Coronary Intervention

Koo, Bon Kwon; Waseda, Katsuhisa; Kang, Hyun–Jae; Kim, Hyo Soo; Nam, Chang Wook; Hur, Seung‐Ho; Kim, Jung Sun; Choi, Donghoon; Jang, Yangsoo; Hahn, Joo Yong; Gwon, Hyeon Cheol; Yoon, Myeong‐Ho; Tahk, Seung Jea; Chung, Woo Young; Cho, Young Seok; Choi, Dong Ju; Hasegawa, Takao; Kataoka, Toru; Oh, Sung Jin; Honda, Yasuhiro; Fitzgerald, Peter J.; Fearon, William F.

doi:10.1161/circinterventions.109.887406

Cited by 158 publications

(137 citation statements)

References 23 publications

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“…Stent implantation over a bifurcation lesion with or without subsequent post-dilation might induce geometrical changes of the SB ostium leading to observations of angiographic SB compromise during the procedure. These geometrical changes appear to be the combination of two effects: (i) the straightening of the MB that stretches the SB, and (ii) the displacement of the carina towards the SB because of stent expansion [7][8][9][10]27 , confirming observations of other numerical studies on single patients 26,28 . Although angiographic images might demonstrate a significant lumen compromise, this is rarely accompanied by a haemodynamically significant compromise, as demonstrated by post-implantation FFR measurements of the SB 7 .…”

Section: Discussionsupporting

confidence: 79%

“…A potential complication of this procedure is the aggravation of side branch (SB) ostial stenosis after stent implantation in the main branch (MB) 1,2 and the associated increased risk of periprocedural myocardial infarction [3][4][5] . SB ostium compromise after PSB has been attributed to plaque shift from the MB into the SB 6 or to the shift of the carina into the SB [7][8][9][10] . Several potential predictors of SB ostium occlusion after MB stenting, including SB lumen diameter 11 , distal bifurcation angle 5,9,12 , MB calcified plaque 13 , SB plaque length 4 and thickness 11…”

Section: Introductionmentioning

confidence: 99%

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Impact of plaque type and side branch geometry on side branch compromise after provisional stent implantation: a simulation study

Iannaccone

Chiastra²,

Καρανάσος³

et al. 2017

EuroIntervention

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Aims: Mechanisms of lumen compromise after provisional side branch (SB) stenting are poorly understood. In this study we aimed to investigate the impact of bifurcation angle, plaque composition, and procedural strategy on SB compromise. Methods and results:Computer simulations of stent implantation were performed in Medina (1,1,1) bifurcation models. Provisional SB stenting was replicated including post-dilation after main branch stenting. Two bifurcation angles (45°, 70°) and four plaque types (fully lipid, fully fibrous, lipid with half and fully calcified ring distal to the carina) were tested. Two post-dilation balloons of different lengths (15 mm and 9 mm) were also investigated. Provisional stenting caused an ovalisation of the SB ostium (i.e., increase of ellipticity from 0.27 to 0.58±0.21, p<0.05) that might appear as a significant stenosis on two-dimensional angiography, although SB ostium area was preserved (-3.3±10.3%) in the absence of calcifications. However, in the presence of calcifications, SB lumen volume compromise was evident (-0.89±0.15 mm 3 ).Plaque type had a higher impact than bifurcation angle on SB ostium shape. A shorter balloon (9 mm) for proximal optimisation reduced SB lumen volume compromise from -1.11 mm 3 to -0.72 mm 3 .Conclusions: Simulations showed ovalisation of the SB ostium, generally without significant lumen compromise. Provisional stenting in the presence of calcifications resulted in a more severe outcome for the SB ostium. KEYWORDS• computer modelling • coronary bifurcations • provisional side branch stenting

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Section: Discussionsupporting

confidence: 79%

Section: Introductionmentioning

confidence: 99%

Impact of plaque type and side branch geometry on side branch compromise after provisional stent implantation: a simulation study

Iannaccone

Chiastra²,

Καρανάσος³

et al. 2017

EuroIntervention

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“…The measurement was performed in the angiographic view in which the foreshortening of the 3 segments was minimal. 7,[12][13][14] …”

Section: Angiographic Analysismentioning

confidence: 99%

Changes in Left Main Bifurcation Geometry After a Single-Stent Crossover Technique

Kang

Mintz²,

Kim³

et al. 2011

Circ: Cardiovascular Interventions

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Background-We assessed geometric changes responsible for acute lumen loss at the left circumflex coronary artery (LCX) ostium after crossover stenting from the left anterior descending coronary artery (LAD) to the left main artery. Methods and Results-Twenty-three left main artery bifurcation lesions with a preprocedural angiographic diameter stenosis Ͻ50% at the LCX ostium were evaluated using prestenting and poststenting intravascular ultrasound pullbacks from both the LAD and the LCX. At the minimal lumen area (MLA) sites within the LCX ostium and at the LCX carina, the lumen, stent, plaqueϩmedia (PϩM), and external elastic membrane (EEM) areas were measured; the EEM eccentricity was calculated at the LCX carina. The change in MLA within the LCX ostium (⌬L), the change in EEM area at the MLA site (⌬V), and the change in PϩM area at the MLA site (⌬P) were calculated. The MLA within the LCX ostium significantly decreased from 5.4 mm 2 (first and third quartiles, 4.3 mm 2 , 7.2 mm 2 ) prestenting to 4.0 mm

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“…[5][6][7] Therefore, recent studies have suggested that carina shift may be a more important mechanism of SBo compromise. [8][9][10][11] Unfortunately, there have been few systemic studies on relative contribution of carina shift and plaque shift using direct evaluation of SB. The aim of our study was to investigate the mechanism of aggravation of SB ostial stenosis after MV stent implantation in coronary bifurcation lesions by volumetric IVUS analysis of both MV and SBo.…”

mentioning

confidence: 99%

Carina Shift Versus Plaque Shift for Aggravation of Side Branch Ostial Stenosis in Bifurcation Lesions

Hahn

Song

et al. 2012

Circ: Cardiovascular Interventions

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Anatomic and Functional Evaluation of Bifurcation Lesions Undergoing Percutaneous Coronary Intervention

Cited by 158 publications

References 23 publications

Impact of plaque type and side branch geometry on side branch compromise after provisional stent implantation: a simulation study

Impact of plaque type and side branch geometry on side branch compromise after provisional stent implantation: a simulation study

Changes in Left Main Bifurcation Geometry After a Single-Stent Crossover Technique

Carina Shift Versus Plaque Shift for Aggravation of Side Branch Ostial Stenosis in Bifurcation Lesions

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