title: Frequency-domain optical coherence tomography findings in patients with bifurcated lesions undergoing provisional stenting.
abstract: OBJECTIVE
  Bifurcations represent challenging lesions which may benefit from improved understanding of stent-related vessel complications. Since optical coherence tomography (OCT) allows us to detect post-stenting vessel injuries, we sought to assess the geographic pattern of stent-related complications occurring during provisional stenting of bifurcated lesions.
  
  
  RESULTS
  Fifty-one patients with bifurcated lesions treated by provisional stenting and undergoing intra-procedural OCT assessment were enrolled. OCT images were acquired with the aim of guiding the percutaneous coronary intervention but were re-analysed off-line for the present study. The stented bifurcation was divided into four segments [three in the main vessel (MV) and one in the side branch (SB)]. The following acute post-stenting vessel injuries/complications at the different bifurcation segments were evaluated: (i) stent under-expansion, (ii) stent malapposition, (iii) stent edge dissection, (iv) side-branch ostium dissection, (v) tissue prolapse, (vi) intracoronary thrombus, and (vii) in-stent dissection. A total of 55 bifurcation lesions undergoing provisional stenting were analysed. At least one OCT complication was detectable in all cases. Across different bifurcation sites, significant differences in the occurrence of stent complications were observed. In particular, stent malapposition was more common at the proximal MV segment (P < 0.001), while tissue prolapse was more common at the distal MV segment (P < 0.001).
  
  
  CONCLUSIONS
  In bifurcated interventions, OCT often detects vessel injuries/stent complications, which tend to have a specific geographical distribution. In particular, stent malapposition is more common at the proximal MV and tissue prolapse at the distal MV segment.
authors.affiliation: Institute of Cardiology, Catholic University of the Sacred Heart, L.go Gemelli 8, Rome 00168, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Burzotta
authors.forename: Giovanni Paolo
authors.initials: GP
authors.lastname: Talarico
authors.forename: Carlo
authors.initials: C
authors.lastname: Trani
authors.forename: Giovanni Luigi
authors.initials: GL
authors.lastname: De Maria
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Pirozzolo
authors.forename: Giampaolo
authors.initials: G
authors.lastname: Niccoli
authors.forename: Antonio Maria
authors.initials: AM
authors.lastname: Leone
authors.forename: Silvia
authors.initials: S
authors.lastname: Saffioti
authors.forename: Italo
authors.initials: I
authors.lastname: Porto
authors.forename: Filippo
authors.initials: F
authors.lastname: Crea
mesh_terms: D000368:Aged; D017023:Coronary Angiography; D003327:Coronary Disease / Q000601:surgery*; D003331:Coronary Vessels / Q000293:injuries*; D005260:Female; D006801:Humans; D007049:Iatrogenic Disease; D007090:Image Interpretation, Computer-Assisted; D008297:Male; D011183:Postoperative Complications / Q000175:diagnosis*; D012189:Retrospective Studies; D015607:Stents; D041623:Tomography, Optical Coherence / Q000379:methods*; D016896:Treatment Outcome
keywords: Bifurcated lesions; Complications; Optical coherence tomography; Percutaneous coronary interventions; Vessel injuries