Abstract 13975: Multi-detector Computed Topographic Predictors of Plaque Shifts to the Side Branch in Left Main Trunk Bifurcation-Associated Percutaneous Coronary Intervention Patients
Objectives: We identified multi-detector computed tomography (MDCT) predictors of plaque shift to the side branch in LMT-associated PCI patients.
Background: Percutaneous coronary intervention (PCI) of bifurcation is associated with a relatively low success rate and a high incidence of procedural complications, including side-branch occlusion and myocardial infarction. In particular, left main trunk (LMT) bifurcation can occur in major side branch stenosis and occlusion, and therefore the accurate prediction of these conditions is essential.
Methods and Results: A series of 97 patients who underwent MDCT and percutaneous coronary intervention (PCI) of LMT bifurcation within 30 days were examined. The patients with prior coronary artery bypass surgery or had heavy calcified lesions confirmed by MDCT were excluded. Finally, total of 67 patients were investigated. The patients were classified into two groups: plaque shift to side-branch (PS) group and the no plaque shift (NPS) group after stenting for target vessels as assessed by coronary angiography. Plaque shift was defined as more than 90% of side-branch ostium or two stages worsening by the American Heart Association classification after stenting. Plaque distribution on MDCT was classified into 6 patterns (plaque A to F; Figure), and then, the correlation between the plaque distribution and the occurrence of plaque shift was examined. As a result, there were no significant differences between the two groups regarding the distribution of bifurcation plaque. The PS group had a significantly higher incidence of carinal plaque in the target vessel (plaque C) than the NPS group (44.0% vs.10.0%, p<0.005).
Conclusion: Plaque distribution assessed by MDCT may have a potential to predict of plaque shift in treating with LMT bifurcation lesion.
- © 2010 by American Heart Association, Inc.