Clinical Implications of Bifurcation Angles in Left Main Bifurcation Intervention Using a Two-Stent Technique

Abstract

Objectives. The aim of this study was to assess the clinical impact of 3 bifurcation angles in left main (LM) bifurcation treated with the 2-stent technique. Background. Data are limited regarding the impact of bifurcation angles after LM percutaneous coronary intervention (PCI). Methods. Using patient-level 4 multicenter registries in Korea, 462 patients undergoing LM bifurcation PCI with the 2-stent technique were identified (181 crush, 167 T-stenting; 63% 1st generation drug-eluting stent (DES), 37% 2nd generation DES). Three bifurcation angles, between the LM and left anterior descending (LAD), the LM and left circumflex (LCX), and the LAD and LCX, were measured. The primary outcome was target lesion failure (TLF), a composite of cardiac death, myocardial infarction, and target lesion revascularization (TLR). Results. In patients treated with the crush technique, the best cutoff value (BCV) to predict TLF was 152° of the LM-LAD angle. In the crush group, a significantly higher TLF rate, mostly driven by TLR, was observed in the LM-LAD angle ≥152° group compared with the <152° group (35.7% vs. 14.6%; adjusted hazard ratio 3.476; 95% confidence interval 1.612–7.492). An LM-LAD angle ≥152° was an independent predictor of TLF. In the T-stenting, no bifurcation angle affected the clinical outcomes. Conclusions. In LM bifurcation PCI using the 2-stent technique, wide LM-LAD angle (≥152°) was associated with a greater risk of TLF in the crush, whereas none of the bifurcation angles affected T-stenting outcomes.

Effect of Stenting Strategy on the Outcome in Patients with Non-Left Main Bifurcation Lesions

“…We did not find an association between the bifurcation angle and long-term outcome in the one-stent group. In contrast, Ki et al [ 31 ] found an angle wider than 152 degrees between the PV and MB to predict TLF in LM bifurcation lesions treated with the crush technique, but not those treated with the T-stenting technique. Using this cut-off of 153 degrees, a similar relationship was observed in our registry in the non-LAD bifurcation group treated with the two-stent strategy, but not in the LAD bifurcation group treated with the same strategy ( Figure S4 ).…”

Impact of coronary bifurcation angle on the pathogenesis of atherosclerosis and clinical outcome of coronary bifurcation intervention–A scoping review

“…not in the cases after T-stenting [55]. A greater area with low shear stress on a long metal overlapping site might be responsible for more restenosis or thrombogenic events in the group with the wider Angle C.…”

“…Ki et al investigated the impact of the BA on clinical outcomes in 462 patients treated with LMCA two-stenting in the COBIS registry [ 51 ]. A wider LMCA-LAD angle (Angle C) was an independent predictor of TLF after crush stenting with a best cut-off value of 152°, but it was not in the cases after T-stenting [ 55 ]. A greater area with low shear stress on a long metal overlapping site might be responsible for more restenosis or thrombogenic events in the group with the wider Angle C.…”