Plaque morphology predictors of side branch occlusion after provisional stenting in coronary bifurcation lesion: Results of optical coherence tomography bifurcation study (ORBID)

Abstract

High lipid content of the MV lesion and a contralateral location of lipid in the bifurcation area may contribute to SBOS after provisional stenting. © 2016 Wiley Periodicals, Inc.

Is side branch lesion length an independent predictor of acute side branch occlusion in provisional strategy? Analysis of 524 consecutive bifurcation lesions

“…Several angiographic studies have shown that a side branch with severe stenosis was susceptible to occlusion . Previous IVUS and OCT studies have also proven that a thicker plaque at the branch side of the main vessel and side branch ostium would facilitate a plaque shift and side branch occlusion . We also noticed that the DS of the SB before MV stenting was an independent predictor in multivariate analysis rather than DS of SB at baseline.…”

“…In both mechanisms, the disease in the ostial segment of SB would play a more important role than the SB lesion length. Angiographic and IVUS studies also consistently reported that the plaque burden of the SB ostium was a risk factor of SB occlusion . Seo et al also reported that the distal segment of SB was not affected by MV stenting .…”

“…However, the risk of side branch occlusion must be carefully reviewed before placement of the stent because occlusion of the large branch is related to periprocedural myocardial infarction (MI) and a disfavored clinical outcome . Several risk factors have been demonstrated by previous studies and include properties of bifurcation anatomies and intervention procedures . However, the role of side branch lesion length remains controversial.…”

Validation of the V‐RESOLVE (Visual Estimation for Risk prEdiction of Side Branch OccLusion in Coronary Bifurcation interVEntion) score system

“…Previous studies have reported predictors of SB occlusion after MV stenting in coronary bifurcation lesions such as true bifurcation lesion, small SB reference, MV plaque thickness, and preprocedural stenosis of the SB ≥ 50% . However, the reported predictors were concluded from analyses by quantitative coronary angiography, optical coherence tomography (OCT), or intravascular ultrasound rather than directly visual estimation.…”

“…Potential reasons might lie in the differences in the bifurcation lesion characteristics between the two cohorts. According to the OCT analysis by Kini et al , bifurcation lesions with SB ostium diameter stenosis >50% were characterized with more frequency of lipid‐rich plaque, more lipid arc, and higher lipid volume index in MV. These characteristics suggested poor fixity of plaque in MV, which led to more likelihood of plaque shift at the bifurcation during MV stenting that compromises the SB ostium and impairs the flow .…”