Abstract 15008: Mechanism and Predictors of Restenosis at the Side Branch Ostium in Coronary Bifurcation Lesions Treated with the 1-Stent Technique: Serial Intravascular Ultrasound Analysis
Background: Restenosis at the SB ostium is one of the major concerns after 1-stent technique. We sought to investigate the mechanisms and predictors of restenosis at the side branch (SB) ostium in coronary bifurcation lesions treated with 1-stent technique.
Methods and Results: Preprocedural, postprocedural, and follow-up intravascular ultrasound (IVUS) images for SB were studied in 99 bifurcation lesions treated with 1-stent technique. The SB ostium was defined as <5 mm distal to the carina. At follow-up, decrease in lumen area at the lesion site of the SB ostium occurred in 49 lesions (49%, group I), whereas no decrease was observed in 50 lesions (51%, group II). Preprocedural positive remodeling (37% versus 10%, p=0.002) and left main lesions (55% versus 30%, p=0.01) were more frequent, and preprocedural vessel area (8.7±3.5 mm2 versus 6.7±2.8 mm2, p=0.002) and plaque area (4.6±2.5 mm2 versus 3.1±1.6 mm2, p=0.001) were larger in group I than those in group II. In group I, 64% of the decrease in lumen area (from 4.6±2.0 mm2 to 3.7±1.8 mm2) was attributable to a decrease in vessel area (from 9.3±3.5 mm2 to 8.8±3.4 mm2) and 36% to an increase in plaque area (from 4.8±2.5 mm2 to 5.1±2.4 mm2). Preprocedural positive remodeling was an independent predictor of lesion progression at the SB ostium (OR 4.1, 95% CI 1.1 to 15.2, p=0.04).
Conclusions: Serial IVUS analysis suggests that both vessel shrinkage and plaque progression contribute to restenosis at the SB ostium after 1-stent technique. Preprocedural positive remodeling may be associated with SB restenosis.
- © 2011 by American Heart Association, Inc.