Abstract 12643: Side Branch Complication after Single Stent Crossover Technique: Prediction with Pre-procedural Optical Coherence Tomography Evaluation
Background: Side branch (SB) ostial stenosis is the most important procedural complication after bifurcation stent implantation. However, pre-procedural predictors are fully unknown. Frequency domain optical coherence tomography (FD-OCT) provides us detailed morphological characteristics around bifurcation lesions. Using FD-OCT, we studied the pre-procedural predictors of SB complications after single-stent crossover technique.
Method: Fifty-two lesions were studied in 49 patients with elective bifurcation stent implantation (69.9 y/o). SB complication was defined as a development of stenosis at SB ostium (>75%). Based on FD-OCT, circumferential plaque distribution around bifurcation lesion was classified into 4 types: the eccentric plaque oriented toward the opposite side of SB (Type 1), the eccentric plaque oriented toward the SB side (Type 2), the eccentric plaque excepting Type 1 or 2 (Type 3), and the concentric plaque (Type 4). In addition, SB angle, angle of carina tip (CT angle), length between proximal branching-point to carina tip (BP-CT length) were evaluated based on the longitudinal reconstruction FD-OCT images.
Results: SB complication was observed in 22 lesions (42.3%). Type 1 distribution was associated with a higher rate of SB complication compared with Type 2, Type 3, and Type 4 (77.3 % vs, 14.3 %, 28.6% ,and 0 %, p≤0.01, respectively). CT angle and BP-CT length were significantly smaller in lesions with SB complication compared with those without (35.5±22.2 vs. 70.9±34.4 degree, p≤0.01; 1.3±0.7 vs. 2.4±0.9, p≤0.01, respectively). ROC analysis indicated CT angle≦51 degree (AUC=0.805, sensitivity 86.4%, specificity 70%) and BP-CT length≦1.75mm(AUC=0.843, sensitivity 77%, specificity 77%) as the best cutoff values for predicting of SB complication after main vessel stenting.
Conclusions: FD-OCT is useful to identify the anatomical features of coronary bifurcation lesions. Narrow CT angle, short BP-CT length and eccentric plaque oriented toward the opposite side of SB were the high risk factors for SB complications after bifurcation stenting. This study indicates that carina shift, but not plaque shift, is an important mechanism of SB complication after single stent crossover technique.
- © 2013 by American Heart Association, Inc.