title: Potential predictors of side-branch occlusion in bifurcation lesions after percutaneous coronary intervention: a coronary CT angiography study.
abstract: OBJECTIVE
  To identify potential predictors of side-branch occlusion after main-vessel (artery) stent implantation in bifurcation lesions by using coronary computed tomography (CT) angiography.
  
  
  METHODS
  This retrospective study was approved by the institutional review board; informed consent was waived. Sixty-five patients with de novo bifurcation lesions underwent coronary CT angiography before percutaneous coronary intervention. By defining side-branch occlusion as Thrombolysis in Myocardial Infarction flow grade 2 or lower, coronary CT angiography plaque characteristics associated with side-branch occlusion (ie, plaque morphology and composition) were analyzed. A multiple logistic regression analysis was undertaken to determine independent potential predictors of side-branch occlusion.
  
  
  RESULTS
  Of 65 patients enrolled, 12 patients (18%) had side-branch occlusion after main-vessel stent implantation. Patients with side-branch occlusion had larger mean plaque thickness in the side-branch side of the proximal main vessel (2.29 mm ± 1.87 [standard deviation] vs 1.29 mm ± 1.43, P = .043), larger plaque thickness in the noncarinal side of the side branch (1.43 mm ± 1.18 vs 0.51 mm ± 0.65, P < .001), smaller side-branch lumen diameter (1.24 mm ± 0.74 vs 1.87 mm ± 0.71, P = .007), and higher diameter stenosis (50.9% ± 24.0 vs 25.5% ± 25.3, P = .002) compared with those without side-branch occlusion. The cutoff value of proximal main vessel plaque thickness was 2.7 mm (area under the curve [AUC], 0.67; 95% confidence interval [CI]: 0.48, 0.86) and of side-branch-diameter stenosis was 40% (AUC, 0.79; 95% CI: 0.67, 0.92). Lesions with plaque thickness in proximal main vessel greater than 2.7 mm and side-branch-diameter stenosis greater than 40% were associated with a 5.6-fold and 6.2-fold, respectively, increased risk of side-branch occlusion.
  
  
  CONCLUSIONS
  Potential coronary CT angiography predictors of side-branch occlusion in bifurcation lesions are plaque thickness in the side-branch side of the proximal main vessel, plaque thickness in the noncarinal side of the side branch, side-branch lumen diameter, and side-branch-diameter stenosis. These potential predictors might guide operators planning the optimal strategy for treating bifurcation lesions.
authors.affiliation: From the Cardiovascular Center, Seoul National University Bundang Hospital, 82 Gumiro-173-gil, Bundang, Seongnam, Gyeonggi, 463-707, South Korea (J.J.P., E.J.C., Y.S.C., I.Y.O., C.H.Y., J.W.S., S.I.C., T.J.Y., I.H.C., D.J.C.); and Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea (B.K.K.).
authors.forename: Jin Joo
authors.initials: JJ
authors.lastname: Park
authors.forename: Eun Ju
authors.initials: EJ
authors.lastname: Chun
authors.forename: Young-Seok
authors.initials: YS
authors.lastname: Cho
authors.forename: Il-Young
authors.initials: IY
authors.lastname: Oh
authors.forename: Chang-Hwan
authors.initials: CH
authors.lastname: Yoon
authors.forename: Jung-Won
authors.initials: JW
authors.lastname: Suh
authors.forename: Sang Il
authors.initials: SI
authors.lastname: Choi
authors.forename: Tae-Jin
authors.initials: TJ
authors.lastname: Youn
authors.forename: Bon-Kwon
authors.initials: BK
authors.lastname: Koo
authors.forename: In-Ho
authors.initials: IH
authors.lastname: Chae
authors.forename: Dong-Ju
authors.initials: DJ
authors.lastname: Choi
mesh_terms: D055424:Cardiac-Gated Imaging Techniques / Q000379:methods; D003287:Contrast Media; D017023:Coronary Angiography / Q000379:methods*; D023921:Coronary Stenosis / Q000000981:diagnostic imaging* / Q000601:surgery*; D005260:Female; D006801:Humans; D007479:Iopamidol / Q000031:analogs & derivatives; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention; D011857:Radiographic Image Interpretation, Computer-Assisted; D012189:Retrospective Studies; D015607:Stents; D014057:Tomography, X-Ray Computed / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D003287:Contrast Media; C057937:iomeprol; D007479:Iopamidol