Influence of parent vessel - side branch distal angle on restenosis rates after main vessel stenting in coronary bifurcation lesion.
OBJECTIVE
This study explores predictors of side branch (SB) compromise in the main vessel only stenting group and its influence on long-term follow-up of the patients.


METHODS
We hypothesised that the geometric factors determining plaque distribution in branching regions influence SB compromise. Angiographic analysis of bifurcation lesions (all Medina types) was performed before, immediately after, and 9-12 months after the procedure. Control angiography was performed when clinically indicated. Specific attention was given to the influence of angle alpha - the angle between main vessel and SB axes.


RESULTS
Fifty-five patients (62 lesions) formed the study group. The LAD lesions were dominant (73%). Drug-eluting stents were used in 48% and kissing balloon inflation in 31%. The value of angle alpha was associated with significant SB stenosis. There was significant worsening of ostial SB stenosis (from 48% to 69%) after main vessel stenting, with the only independent predictor angle alpha. For SB ostial MLD independent predictors were angle alpha, SB vessel diameter and MB reference diameter. Predictors of SB occlusion (6.5%) were angle alpha <30 degrees and age >82 years. At follow-up (mean 11 months) SB restenosis rate was 52%, but was associated with symptoms only if the main vessel was affected (8/55, 15%). Angle alpha and main vessel reference diameter, main branch minimal diameter after stenting and stent type were predictors of target vessel revascularisation rate (25%).


CONCLUSIONS
Angle alpha predicts SB compromise after main vessel stenting and is the main predictor of restenosis in the main vessel.
Gil
Robert J
RJ
Invasive Cardiology Department, Central Hospital of the Internal Affairs and Administration Ministry, Warsaw, Poland. scorpirg@fiber.net.pl
Vassilev
Dobrin
D
Rzezak
Jarosław
J
Słysz
Andrzej
A
Krzyzewski
Rafał
R
Kulawik
Tomasz
T
D000368:Aged; D000704:Analysis of Variance; D003324:Coronary Artery Disease / Q000628:therapy*; D023903:Coronary Restenosis / Q000209:etiology* / Q000517:prevention & control*; D023921:Coronary Stenosis / Q000601:surgery*; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011044:Poland; D012720:Severity of Illness Index; D015607:Stents / Q000009:adverse effects*; D013997:Time Factors