The Carina Angle—New Geometrical Parameter Associated with Periprocedural Side Branch Compromise and the Long‐Term Results in Coronary Bifurcation Lesions with Main Vessel Stenting Only

Abstract

Smaller carina angle with straightening of MV-main branch from stent implantation in coronary bifurcations predicted higher SB compromise, restenosis, and MACE rates during follow-up of 1 year.

Changes in Left Main Bifurcation Geometry After a Single-Stent Crossover Technique

“…Gil et al 4 reported that a smaller distal carina angle predicted higher side branch compromise and major cardiovascular events at 1-year follow-up in patients with bifurcation lesions treated with a single main-vessel stent (crossover technique). The current data were consistent and extended these observations in that a smaller distal angiographic carina angle prestenting was associated with a much greater percent reduction in lumen area of the LCX carina poststenting because a smaller distal carina angle was a predictor of carinal shift, the main mechanism of lumen loss during crossover stenting.…”

Clinical Utility and Significance of Intravascular Ultrasound and Optical Coherence Tomography in Guiding Percutaneous Coronary Interventions

“…23 Our group previously identified 81 bifurplaque protrusion inside a stent, such findings detected only by OCT may not be clinically relevant. 10,11…”

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.…”

“…[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.…”