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Optical coherence tomography assessment of a complex bifurcation lesion treated with double kissing Crush technique:
Jin-Zan Cai1, Yao-Jun Zhang, Tian Xu
1Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China Department of Cardiovascular Sciences, University College London Department of Cardiology, Barts Heart Centre, London, UK.
Insights
Optical coherence tomography (OCT) can better assess coronary bifurcation lesion complexity than angiography. This imaging technique guided treatment for a complex case, showing excellent outcomes.
Area of Science:
- Interventional Cardiology
- Medical Imaging
- Vascular Biology
Background:
- The DEFINITION study proposed a classification for coronary bifurcation lesion complexity using coronary angiography.
- Coronary angiography has limitations in resolution, potentially leading to inaccurate complexity assessment.
Observation:
- Optical coherence tomography (OCT) was used to re-evaluate a coronary bifurcation lesion initially classified as "simple" by DEFINITION criteria.
- OCT revealed the lesion to be "complex," contradicting the initial angiographic assessment.
Findings:
- A "complex" coronary bifurcation lesion was successfully treated using a double kissing Crush stenting approach.
- Both immediate and long-term results assessed by angiography and OCT were excellent.
Implications:
- OCT may be a superior imaging modality for accurately classifying coronary bifurcation lesion complexity.
- Accurate complexity assessment with OCT can guide optimal treatment strategies for bifurcation lesions.
Abstract:
The DEFINITION (Impact of the complexity of bifurcation lesions treated with drug-eluting stents) study has provided a novel classification to evaluate the complexity of coronary bifurcation lesion according to coronary angiography, but angiographic imaging due to its low resolution and inherited limitation may result in an inaccurate adjudication.We used optical coherence tomography (OCT) to further evaluate the coronary characteristics in a patient with "simple" bifurcation lesion which was classified by the DEFINITION criteria. However, a "complex" bifurcation lesion was defined and confirmed according to the OCT results.A double kissing Crush stenting approach was adopted to treat this "complex" case finally. The immediate and long-term angiographic and OCT results were excellent.OCT may be useful imaging modality to classify complexity of coronary bifurcation lesion and subsequently guide its treatment strategy.
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