Clinical Verification of a Theory for Predicting Side Branch Stenosis after Main Vessel Stenting in Coronary Bifurcation Lesions

Abstract

Our analysis shows that the most powerful independent predictor of SB compromise is a new variable angle alpha.

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

“…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 .…”

Predictors for Side Branch Failure During Provisional Strategy of Coronary Intervention for Bifurcation Lesions (from the Korean Bifurcation Registry)

“…Recently, Vassilev et al showed that the most powerful independent predictor for SB compromise is angle α, which is the angle between the main vessel axis before SB and the internal side of the SB wall, extending up to the flow divider [21]. This angle corresponds to 180-MV angle in our data.…”

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

“…4 However, some angiographic studies have demonstrated that a stent-induced increase in lumen diameter of the MVd shifted the carina into the SBo, and this carina shift was the main mechanism of SB ostial narrowing after MV stent implantation. 8,9 A recent IVUS study indicated that the vessel and lumen volumes increased in both the MVp and MVd, whereas only the plaque volume of the MVp decreased and the plaque volume of the MVd remained unchanged after MV stenting. 10 The authors speculated that the degree of luminal narrowing of an SB after stenting of the MV was a result of carina shift.…”

“…Vassilev et al 8 reported that carina angle was the most powerful independent predictor of SBo compromise in their quantitative coronary angiography analysis. 8 And Kang et al 11 also found that narrow carina angle between the left anterior descending and the left circumflex coronary artery and wide angle between the left circumflex coronary artery and the left main lesions were associated with a greater lumen area loss at the left circumflex coronary artery ostium. 11 But in our study, we could not find any correlation between bifurcation angle or carina angle and SBo compromise, carina shift, or plaque shift.…”

“…[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.…”