Predictors of ostial side branch damage during provisional stenting of coronary bifurcation lesions not involving the side branch origin: an ultrasonographic study.
OBJECTIVE
To analyse the ultrasound anatomy of bifurcation lesions {1,1,0},{0,1,0} and {1,0,0} of the Medina classification in order to identify predictors of angiographic side branch (SB) damage after main branch (MB) stenting.


RESULTS
One hundred and ten patients with Medina classification bifurcation lesions of {1,1,0},{0,1,0} and {1,0,0} were recruited. An intravascular ultrasound study (IVUS) was performed on the MB before treatment, after stent implantation and after SB intervention. A quantitative analysis was conducted in combination with a qualitative study of the carina morphology and plaque distribution. Ostial SB damage (an increase of the percentage of ostial stenosis by QCA ≥30%) was observed in 51 lesions (48%) after MB stenting. The baseline IVUS identified a carina with a spiky morphology ("eyebrow" sign) in 51 bifurcations. In 41 out of 51 bifurcations with this sign, ostial SB damage was induced after stenting the MB due to carina shift (p<0.01). Narrower angiographic angles were associated with the presence of the "eyebrow" sign (62º±23º vs. 76º±24º, p<0.05). Plaque located at the carina was associated with a lower rate of ostial SB damage (29%) when compared with those lesions with no plaque exhibiting at the carina (51%), p<0.05.


CONCLUSIONS
The "eyebrow" sign is a powerful predictor of ostial SB damage after stent implantation in the MB in bifurcation coronary lesions without plaque involving the SB.
Department of Cardiology, Reina Sofia Hospital, University of Córdoba (IMIBIC), Córdoba, Spain. jslht@yahoo.es
Javier
J
Suárez de Lezo
Alfonso
A
Medina
Pedro
P
Martín
José
J
Novoa
José
J
Suárez de Lezo
Manuel
M
Pan
Eduardo
E
Caballero
Francisco
F
Melián
Francisco
F
Mazuelos
Verónica
V
Quevedo
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000145:classification / Q000628:therapy*; D023921:Coronary Stenosis / Q000145:classification / Q000628:therapy; D003330:Coronary Vessel Anomalies / Q000000981:diagnostic imaging*; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000293:injuries*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D015607:Stents / Q000009:adverse effects*; D018084:Ultrasonography, Interventional