Side branch occlusion complicating percutaneous transluminal coronary angioplasty.

Abstract

A frequent concern during angioplasty is the possibility of occluding important side branches that originate in arterial stenoses subjected to balloon dilatation. The effect of dilatation on 93 side branches (greater than or equal to 1 mm in diameter) was evaluated in 86 patients undergoing percutaneous transluminal coronary angioplasty (PTCA) in whom those branches arose directly in dilated segments of the left anterior descending, circumflex, or right coronary arteries. Seventy-six of the 93 side branches had minor (less than 50%) narrowing at their origin. Among these side branches, nine (12%) were compromised by PTCA. Seventeen of the 93 side branches had greater than 50% ostial stenosis. Significantly more of these side branches (seven of seventeen, or 41%) were compromised by PTCA (P less than .01). Even when compromise does occur, it usually takes the form of increased stenosis rather than total occlusion. The presence of side branches originating in stenotic lesions is not a contraindication to PTCA since serious compromise of such branches rarely results from this procedure.

Intravascular Ultrasound Predictors of Side Branch Occlusion in Bifurcation Lesions After Percutaneous Coronary Intervention

“…2 The current study confirmed that side branches with ≥50% ostial stenosis were at higher risk for occlusion than those without ostial stenosis. Since the beginning of the stent era, stent implantation in coronary lesions involving side branches has been recognized as a potential source of acute complications.…”

“…. [1][2][3][4][5] Meier et al were among the first to identify the risk of side branch occlusion associated with parent vessel angioplasty. 1 They emphasized that side branches involved in vessel narrowing are at high risk for side branch occlusion during PCI.…”

“…Boxt et al has reported that vessels with angiographic ostial stenosis >50% have a higher risk of occlusion than those without ostial stenosis. 2 Prior studies have demonstrated that intravascular ultrasound (IVUS) provides information not generated by angiography alone, and the use of sonographic measurements of vascular dimensions has improved short-and long-term outcomes. 6-10 Despite several lines of evidence suggesting that IVUS guidance can reduce the need for target lesion revascularization after PCI, 9,10 it remains controversial whether preintervention IVUS findings can help to identify side branches likely to occlude after PCI of bifurcation lesions.…”

Strategies for drug‐eluting stent treatment of bifurcation coronary artery disease in the United States: Insights from the e‐Cypher S.T.L.L.R.Trial

“…Previous reports have shown that significant stenosis at the SB ostium is an important predictor of SB occlusion after bifurcation PCI [35][36][37]. However, stenosis severity and diameters of the MB or SB had minimal influence on selection of PCI strategy in the present study.…”

Side branch complication after a single-stent crossover technique

“…When there is extensive atheromatous plaque affecting the SB ostium, plaque shift may be more importantly involved in the development of SB complication. Actually, previous studies with a bare metal sent or a drug-eluting stent have shown that SB with at least 50% ostial stenosis was a higher risk for occlusion than those without ostial stenosis [16,17].…”