TCT-391 Predictors and Outcomes of Side Branch Occlusion after Main Vessel Stenting in Coronary Bifurcation Lesions: Results from the COBIS (COronary BIfurcation Stenting) II Registry

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

“…According to our simulations, the bifurcation angle had no significant impact on SB ostium area or SB volume reduction after provisional stent implantation and post-dilation, as the differences between these metrics were minimal between cases with 45º or 70º distal bifurcation angles and the same plaque type. Although this result is in line with clinical studies that have found no correlation between the distal angle and the SB compromise 4,8,29 , other works have identified the presence of a wide 5,12 or narrow 9,13 distal angle as a potential predictor of SB compromise after MB stenting. Significant differences were observed based on plaque composition, with fibrous or lipid plaques having nearly unaffected lumen dimensions, and calcified plaques demonstrating important variations of lumen area and volume, irrespective of the distal bifurcation angle.…”

“…Currently, the standard of care to treat a bifurcation lesion is the provisional side branch (PSB) approach 1 . A potential complication of this procedure is the aggravation of side branch (SB) ostial stenosis after stent implantation in the main branch (MB) 1,2 and the associated increased risk of periprocedural myocardial infarction [3][4][5] . SB ostium compromise after PSB has been attributed to plaque shift from the MB into the SB 6 or to the shift of the carina into the SB [7][8][9][10] .…”

“…SB ostium compromise after PSB has been attributed to plaque shift from the MB into the SB 6 or to the shift of the carina into the SB [7][8][9][10] . Several potential predictors of SB ostium occlusion after MB stenting, including SB lumen diameter 11 , distal bifurcation angle 5,9,12 , MB calcified plaque 13 , SB plaque length 4 and thickness 11…”

Long-Term Clinical Outcomes of True and Non-True Bifurcation Lesions According to Medina Classification – Results From the COBIS (COronary BIfurcation Stent) II Registry –

“…This hypothesis was well-supported by our recently published study. 12 Among true bifurcation lesions, Medina (1.1.1) and (0.1.1) were associated with a higher risk of cardiac death or MI than Medina (1.0.1). Although Medina (1.0.1) was classified with the true bifurcation lesions and had a high prevalence of SB occlusion, patients with Medina (1.0.1) lesions had similar long-term clinical outcomes to those with non-true bifurcation lesions.…”

“…Bifurcation lesions were divided into 3 segments for quantitative coronary angiographic analysis: proximal MV, distal MV, and SB ostium. 12 We determined the minimum luminal diameter (MLD) and reference diameter (RD) for each segment. In the distal MV and SB ostium, MLDs were measured <5 mm distal to the SB take-off.…”