Bifurcation lesion morphology and intravascular ultrasound assessment

Abstract

This repot reviews the angiographic and intravascular (IVUS) assessment of coronary bifurcation lesions. Overall, bifurcation lesion anatomy and morphology is critical for technical decision making, and a key factor for successful bifurcation PCI. Optimal viewing is essential for proper angiographic assessment, especially for evaluation of the degree of SB involvement. Current classifications based on the presence or absence of significant angiographic stenosis within the three segments of the bifurcation anatomy may not provide sufficient anatomic and morphologic information to guide technical decision making. Dedicated 2D bifurcation quantitative coronary angiography with segmental analysis of the bifurcation provides greater accuracy for quantification of the degree of stenosis in the PV and especially the SB ostium. IVUS assessment at preprocedure provides valuable information regarding vessel size, and plaque morphology and distribution (particularly in relation to the SB ostium) that may help select treatment strategy. At postprocedure, IVUS imaging evaluates stent apposition within the stented segment(s) and the appropriateness of stent expansion particularly at the SB ostium, what may impact long-term outcomes.

Dedicated Bifurcation Paclitaxel‐Eluting Stent BiOSS Expert® in the Treatment of Distal Left Main Stem Stenosis

“…The continuous advancement of angioplasty procedures broadens the range of lesions which could be safely treated with PCI. Bifurcation stenosis in distal LMS is one such case, whose rate is systematically increasing in the population of patients subjected to PCI . Our study showed a high rate of device success with favorable acute and long‐term clinical results expressed by MACE rate at 12 months.…”

Dedicated bifurcation stents or regular drug eluting stents in distal left main stenosis: A retrospective study

“…Bifurcation stenosis in distal LM stem is one of such cases and its rate is systematically increasing in the population of patients subjected to PCI [12]. This study showed a high rate of device success (100%) with favorable acute and long-term clinical results expressed by MACE rate at 12 as well as 36 months, 9.5% and 19%, respectively.…”

Cardiovascular imaging 2011 in the International Journal of Cardiovascular Imaging

“…Costa et al [5] reported about the bifurcation lesion morphology and the intravascular ultrasound assessment. It is their view that the bifurcation lesion anatomy and morphology is critical for clinical decision making, and a key factor for successful bifurcation PCI.…”

“…The assessment of coronary bifurcation lesions by IVUS was extensively reviewed by Costa et al [5]; practical aspects to be considered on a daily basis in the catheterization laboratory, such as pre-stent evaluation of vessel size, plaque morphology and its distribution, as well as post-procedure assessment of stent expansion and apposition were highlighted. Shin et al [19] applied the methodology (i.e., Shin’s method) using VH-IVUS to identify dense calcium volume and percent necrotic core to EEM as independent predictors of CK-MB elevation post successful, elective stent implantation.…”

“…Costa et al [5] discussed the value of IVUS in the evaluation of bifurcation lesions. IVUS provides valuable information regarding vessel size and plaque morphology and distribution that may help select treatment strategy.…”