Angiographic determinants for side branch treatment in distal unprotected left main coronary artery bifurcation percutaneous coronary intervention with single stent crossover technique
DOI:
https://doi.org/10.18203/2320-6012.ijrms20193386Keywords:
Bifurcation angle, Coronary artery bypass graft, Left main coronary artery, Percutaneous coronary intervention, Polygon of confluence, Qualitative coronary analysis, SYNTAX scoreAbstract
Background: The aim of this study was to analyze angiographic parameters such as bifurcation angle, diameter at the polygon of confluence (POC) and SYNTAX score in predicting the need for side branch treatment with single-stent crossover technique from distal unprotected left main coronary artery (ULMCA) to the major side branch.
Methods: This was a retrospective and observational study. A total of 83 patients with distal ULMCA lesions were enrolled. Patients who underwent provisional single-stent crossover technique were compared with patients that required side branch treatment though plain old balloon angioplasty (POBA) 5 (6.0%) or stenting 7 (8.4%). Angiographic parameters, bifurcation angle, diameter at the POC and the SYNTAX score were analyzed for their ability to predict the need for side branch treatment.
Results: Mean age of patients was 58.2±5.3 years. Males constituted 61 (73.5%) patients. Post main branch stenting 5 (6.0%) and 7 (8.4%) patients required side branch treatment with POBA and stent implantation, respectively. Binary regression revealed bifurcation angle (Z: 1.15, OR: 0.99, 95% CI: 0.97-1.01, p=0.25), diameter at the POC (Z: 1.1, OR: 0.82, 95% CI: 0.32-2.13, p=0.272) and SYNTAX score (Z: 1.51, OR: 1.18, 95% CI: 0.95-1.45, p=0.132) did not correctly predict the requirement of side branch treatment.
Conclusion: Left main coronary artery to main branch stenting can be performed safely with single-stent crossover technique, irrespective of presence of side branch disease across a wide range of bifurcation angles, diameters at the POC and SYNTAX scores.
References
Fihn SD, Blankenship JC, Alexander KP, Bittl JA, Byrne JG, Fletcher BJ, et al. ACC/AHA/AATS/PCNA/SCAI/STS focused update of the guideline for the diagnosis and management of patients with stable ischemic heart disease: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines, and the American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Am Coll Cardiol. 2014;64(18):1929-49.
Members ATF, Windecker S, Kolh P, Alfonso F, Collet J-P, Cremer J, et al. 2014 ESC/EACTS guidelines on myocardial revascularization: The Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS) developed with the special contribution of the European Association of Percutaneous Cardiovascular Interventions (EAPCI). Eur Heart J. 2014;35(37):2541-19.
Kim WJ, Kim YH, Park DW, Yun SC, Lee JY, Kang S-J, et al. Comparison of single-versus two-stent techniques in treatment of unprotected left main coronary bifurcation disease. Catheter Cardiovasc Interv. 2011;77(6):775-82.
Morice M-C, Serruys PW, Kappetein AP, Feldman TE, Ståhle E, Colombo A, et al. Five-year outcomes in patients with left main disease treated with either percutaneous coronary intervention or coronary artery bypass grafting in the SYNTAX trial. Circulation. 2014Jun10;129(23):2388-94.
Stone GW, Sabik JF, Serruys PW, Simonton CA, Généreux P, Puskas J, et al. Everolimus-eluting stents or bypass surgery for left main coronary artery disease. N Engl J Med. 2016;375(23):2223-35.
Pavei A, Oreglia JA, Martin G, Tousek P, Sharif F, Farah B, et al. Long-term follow-up of percutaneous coronary intervention of unprotected left main lesions with drug eluting stents: Predictors of clinical outcome. Euro Intervention. 2009;4(4):457-63.
Kang S-J, Mintz GS, Kim WJ, Lee JY, Park DW, Lee S-W, et al. Preintervention angiographic and intravascular ultrasound predictors for side branch compromise after a single-stent crossover technique. Am J Cardiol. 2011;107(12):1787-93.
Kang SJ, Ahn JM, Kim WJ, Lee JY, Park DW, Lee SW, et al. Functional and morphological assessment of side branch after left main coronary artery bifurcation stenting with cross-over technique. Catheter Cardiovasc Interv. 2014;83(4):545-52.
Zhang D, Xu B, Yin D, Li Y-P, He Y, You S-J, et al. Clinical and angiographic predictors of major side branch occlusion after main vessel stenting in coronary bifurcation lesions. Chin Med J. 2015;128(11):1471-8.
Tomasello SD, Costanzo L, Galassi AR. Quantitative coronary angiography in the interventional cardiology. Advances in the Diagnosis of Coronary Atherosclerosis: In Tech. 2011:255-72.
Song YB, Hahn J-Y, Yang JH, Choi S-H, Choi J-H, Lee SH, et al. Differential prognostic impact of treatment strategy among patients with left main versus non–left main bifurcation lesions undergoing percutaneous coronary intervention: results from the COBIS (Coronary Bifurcation Stenting) Registry II. JACC Cardiovasc Interv. 2014;7(3):255-63.
Toyofuku M, Kimura T, Morimoto T, Hayashi Y, Ueda H, Kawai K, et al. Three-year outcomes after sirolimus-eluting stent implantation for unprotected left main coronary artery disease: insights from the j-Cypher registry. Circulation. 2009;120(19):1866-74.
Zhang D, Dou K. Coronary bifurcation intervention: What role do bifurcation angles play? J Interv Cardiol. 2015;28(3):236-48.
Zhang D, Xu B, Yin D, Li Y, He Y, You S, et al. How bifurcation angle impacts the fate of side branch after main vessel stenting: A retrospective analysis of 1,200 consecutive bifurcation lesions in a single center. Catheter Cardiovasc Interv 2015;85(S1):706-15.
Kang S-J, Mintz GS, Oh JH, Park DW, Lee SW, Kim Y-H, et al. Intravascular ultrasound assessment of distal left main bifurcation disease: the importance of the polygon of confluence of the left main, left anterior descending, and left circumflex arteries. Catheter Cardiovasc Interv. 2013;82(5):737-45.
