Anatomic and functional evaluation of bifurcation lesions undergoing percutaneous coronary intervention.
BACKGROUND
We sought to investigate the mechanism of geometric changes after main branch (MB) stent implantation and to identify the predictors of functionally significant "jailed" side branch (SB) lesions.


RESULTS
Seventy-seven patients with bifurcation lesions were prospectively enrolled from 8 centers. MB intravascular ultrasound was performed before and after MB stent implantation, and fractional flow reserve was measured in the jailed SB. The vessel volume index of both the proximal and distal MB was increased after stent implantation. The plaque volume index decreased in the proximal MB (9.1+/-3.0 to 8.4+/-2.4 mm(3)/mm, P=0.001), implicating plaque shift, but not in the distal MB (5.4+/-1.8 to 5.3+/-1.7 mm(3)/mm, P=0.227), implicating carina shifting to account for the change in vessel size (N=56). The mean SB fractional flow reserve was 0.71+/-0.20 (N=68) and 43% of the lesions were functionally significant. Binary logistic-regression analysis revealed that preintervention % diameter stenosis of the SB (odds ratio=1.05; 95% CI, 1.01 to 1.09) and the MB minimum lumen diameter located distal to the SB ostium (odds ratio=3.86; 95% CI, 1.03 to 14.43) were independent predictors of functionally significant SB jailing. In patients with > or =75% stenosis and Thrombolysis In Myocardial Infarction grade 3 flow in the SB, no difference in post-stent angiographic and intravascular ultrasound parameters was found between SB lesions with and without functional significance.


CONCLUSIONS
Both plaque shift from the MB and carina shift contribute to the creation/aggravation of an SB ostial lesion after MB stent implantation. Anatomic evaluation does not reliably predict the functional significance of a jailed SB stenosis.
Koo
Bon-Kwon
BK
Division of Cardiovascular Medicine, Interventional Cardiology, Stanford University Medical Center, 300 Pasteur Drive, Stanford, CA 94305, USA.
Waseda
Katsuhisa
K
Kang
Hyun-Jae
HJ
Kim
Hyo-Soo
HS
Nam
Chang-Wook
CW
Hur
Seung-Ho
SH
Kim
Jung-Sun
JS
Choi
Donghoon
D
Jang
Yangsoo
Y
Hahn
Joo-Yong
JY
Gwon
Hyeon-Cheol
HC
Yoon
Myeong-Ho
MH
Tahk
Seung-Jea
SJ
Chung
Woo-Young
WY
Cho
Young-Seok
YS
Choi
Dong-Ju
DJ
Hasegawa
Takao
T
Kataoka
Toru
T
Oh
Sung Jin
SJ
Honda
Yasuhiro
Y
Fitzgerald
Peter J
PJ
Fearon
William F
WF
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects; D003324:Coronary Artery Disease / Q000150:complications / Q000175:diagnosis / Q000473:pathology / Q000628:therapy*; D023921:Coronary Stenosis / Q000175:diagnosis / Q000209:etiology* / Q000473:pathology*; D005260:Female; D053805:Fractional Flow Reserve, Myocardial; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011446:Prospective Studies; D018084:Ultrasonography, Interventional