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Long-Term Lesion Progression After Left Main Distal Bifurcation Stenting: Insights From Bifurcation Angle Variation
En Chen1,2,3, Danqing Hu4, Hong Zheng1,2,3
1Department of Cardiology, Fujian Medical University Union Hospital, Fujian Medical University, 350001 Fuzhou, Fujian, China.
Background:
The clinical impact of changes in the bifurcation angle throughout the cardiac cycle (BAC) after percutaneous coronary intervention (PCI) for left main coronary bifurcation lesions (LMCBLs) remains controversial, and the associated long-term evolution post-stenting remains unknown. Therefore, this study aimed to evaluate temporal changes in the BAC and the related impact on lesion progression in patients undergoing single- or dual-stenting.
Methods:
Proximal (PBAC) and distal (DBAC) bifurcation angles were quantified throughout the cardiac cycle using two-dimensional quantitative coronary angiography at optimal views before the procedure, immediately after, and at long-term follow-up. These measurements represented the absolute difference between the end-diastolic and end-systolic angles for the left main (LM) to the left circumflex (LCX) and for the left anterior descending (LAD) to the LCX. Lesion progression was assessed from increases in diameter stenosis percentage (iDS%) from post-procedure to follow-up.
Results:
A total of 284 patients underwent single-stenting (LM-LAD), and 84 underwent dual stenting (LM-LAD-LCX). Changes in the PBAC were unaffected by interventional strategies or time. The DBAC was narrowed post-stenting in all patients, but rebounded to pre-procedural levels during follow-up in the single-stenting group. In contrast, the DBAC remained at post-procedural levels in the dual-stenting group. Lesion progression was more pronounced in patients with dual stenting, particularly in the LCX. The pre-procedural PBAC correlated linearly with the iDS%-LCX metric in the dual stenting.
Conclusions:
The PBAC remained stable over time and across strategies, whereas the DBAC decreased post-stenting. During follow-up, the DBAC rebounded in the single-stenting group but remained low in the dual-stenting group. The pre-procedural PBAC represents an independent anatomical risk marker for future LCX progression in patients with dual-stented LMCBLs.
