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Potential predictors of side-branch occlusion in bifurcation lesions after percutaneous coronary intervention: a
Jin Joo Park1, Eun Ju Chun, Young-Seok Cho
1From the Cardiovascular Center, Seoul National University Bundang Hospital, 82 Gumiro-173-gil, Bundang, Seongnam, Gyeonggi, 463-707, South Korea (J.J.P., E.J.C., Y.S.C., I.Y.O., C.H.Y., J.W.S., S.I.C., T.J.Y., I.H.C., D.J.C.); and Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea (B.K.K.).
Insights
Coronary CT angiography identified key predictors of side-branch occlusion after stenting bifurcation lesions. Plaque thickness and diameter stenosis are crucial factors to consider for optimal treatment strategies.
Area of Science:
- Cardiovascular Imaging
- Interventional Cardiology
- Radiology
Background:
- Bifurcation lesions pose challenges in stenting, with potential for side-branch occlusion.
- Accurate prediction of side-branch occlusion is vital for successful percutaneous coronary intervention (PCI).
Purpose of the Study:
- To identify predictors of side-branch occlusion after main-vessel stent implantation in coronary artery bifurcation lesions.
- Utilize coronary computed tomography (CT) angiography to analyze plaque characteristics associated with side-branch occlusion.
Main Methods:
- Retrospective analysis of 65 patients with de novo bifurcation lesions undergoing coronary CT angiography before PCI.
- Coronary CT angiography assessed plaque morphology and composition, defining side-branch occlusion by Thrombolysis in Myocardial Infarction (TIMI) flow grade 2 or lower.
- Multiple logistic regression identified independent predictors of side-branch occlusion.
Main Results:
- 18% of patients experienced side-branch occlusion post-stenting.
- Significant predictors included larger plaque thickness (proximal main vessel and side branch), smaller side-branch lumen diameter, and higher diameter stenosis.
- Cutoff values for proximal main vessel plaque thickness (2.7 mm) and side-branch diameter stenosis (40%) were identified, significantly increasing occlusion risk.
Conclusions:
- Coronary CT angiography reveals significant predictors of side-branch occlusion in bifurcation lesions.
- Plaque thickness and diameter stenosis are key indicators that can guide procedural planning.
- These findings may help optimize stenting strategies for bifurcation lesions, reducing the risk of complications.
Purpose:
To identify potential predictors of side-branch occlusion after main-vessel (artery) stent implantation in bifurcation lesions by using coronary computed tomography (CT) angiography.
Materials And Methods:
This retrospective study was approved by the institutional review board; informed consent was waived. Sixty-five patients with de novo bifurcation lesions underwent coronary CT angiography before percutaneous coronary intervention. By defining side-branch occlusion as Thrombolysis in Myocardial Infarction flow grade 2 or lower, coronary CT angiography plaque characteristics associated with side-branch occlusion (ie, plaque morphology and composition) were analyzed. A multiple logistic regression analysis was undertaken to determine independent potential predictors of side-branch occlusion.
Results:
Of 65 patients enrolled, 12 patients (18%) had side-branch occlusion after main-vessel stent implantation. Patients with side-branch occlusion had larger mean plaque thickness in the side-branch side of the proximal main vessel (2.29 mm ± 1.87 [standard deviation] vs 1.29 mm ± 1.43, P = .043), larger plaque thickness in the noncarinal side of the side branch (1.43 mm ± 1.18 vs 0.51 mm ± 0.65, P < .001), smaller side-branch lumen diameter (1.24 mm ± 0.74 vs 1.87 mm ± 0.71, P = .007), and higher diameter stenosis (50.9% ± 24.0 vs 25.5% ± 25.3, P = .002) compared with those without side-branch occlusion. The cutoff value of proximal main vessel plaque thickness was 2.7 mm (area under the curve [AUC], 0.67; 95% confidence interval [CI]: 0.48, 0.86) and of side-branch-diameter stenosis was 40% (AUC, 0.79; 95% CI: 0.67, 0.92). Lesions with plaque thickness in proximal main vessel greater than 2.7 mm and side-branch-diameter stenosis greater than 40% were associated with a 5.6-fold and 6.2-fold, respectively, increased risk of side-branch occlusion.
Conclusion:
Potential coronary CT angiography predictors of side-branch occlusion in bifurcation lesions are plaque thickness in the side-branch side of the proximal main vessel, plaque thickness in the noncarinal side of the side branch, side-branch lumen diameter, and side-branch-diameter stenosis. These potential predictors might guide operators planning the optimal strategy for treating bifurcation lesions.
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