Carina Bifurcation Angle and Side Branch Occlusion in Coronary Bifurcation Lesions Intervention: Angiographic Lesions Characteristic Role in Determining Its Relation

Abstract

Side branch occlusion has been implicated as a complication after percutaneous coronary intervention in coronary bifurcation lesions. The role of carina bifurcation angle as one of the characteristics of the coronary bifurcation lesions in causing side branch occlusion after percutaneous coronary intervention is still debated. This study aims to assess the correlation between carina bifurcation angles as one of the characteristics of the coronary bifurcation lesions and side branch occlusion in elective percutaneous coronary intervention. This is a cross-sectional study which utilizes CAAS 5.1 software to measure carina bifurcation angle. We collected 113 lesions in 108 patients that met the inclusion criteria from January 2016 to October 2016. Side branch occlusion occurred in 15 lesions (13.3%), with median carina bifurcation angle 19.17 degrees (p < 0.001). Multivariate analysis showed there is a correlation between carina bifurcation angle with side branch occlusion, OR (odds ratio) 0.86 (95% CI [confidence interval]: 0.80–0.92) with ≤ 33.71 degrees cut off value. Increased risk of side branch occlusion was found in small carina bifurcation angle.

A Novel Strategy to Simplify the Procedures in Treating Complicated Coronary Bifurcation Lesions: From a Bench Test to Clinical Application

“…According to previous studies, the incidence of SB complications was 5-15% using jailed wire-based provisional stenting in bifurcation interventions. The application of the JBT could decrease the incidence to below 5% (23). In the present study, we did not find any non-rescuable SB closure, suggesting that the JB-POT protocol is an effective strategy for the protection of risked SBs in provisional stenting.…”

“…Most patients were men with hypertension and dyslipidemia and were smokers, and all of them were diagnosed with acute coronary syndrome. According to our experience and previous studies (23)(24)(25), these patients are vulnerable to SB complications during onestent crossover intervention. The angiographic characteristics are listed in Table 2.…”

“…Previously, several studies were designed to explore risk factors for SB complications in crossover stenting protocols. Many risk factors, such as a small bifurcation angle, carina tip-branching point length and stenosis at the SB ostium, were associated with a significantly higher incidence of SB ostial stenosis (23)(24)(25). However, the overwhelming workload of clinicians requires a simple way to predict SB complications.…”

Role of Intravascular Ultrasound in Prediction of Acute Side Branch Occlusion in Coronary Artery Bifurcation Lesions Just After Provisional Stenting

“…Several studies compared findings with angiographic evaluation alone versus under the guidance of IVUS, and showed lower major adverse cardiac events (MACE) and cardiac death rates at follow up were seen in the IVUS group 7,8, 9 . At the beginning of the procedure, risk factors for SB occlusion after provisional stenting technique should be recognized such as SB stenosis and acute angel of SB [10][11][12][13][14][15] . In this study, we are trying to understand the usefulness of IVUS to help in the prediction of SB collapse after provisional stenting.…”