Three-Dimensional Optical Coherence Tomographic Analysis of Eccentric Morphology of the Jailed Side-Branch Ostium in Coronary Bifurcation Lesions.
BACKGROUND
The severity of angiographic diameter stenosis of the jailed side-branch ostium is usually overestimated over the 3-D optical coherence tomography (OCT)-measured actual stenosis. Using 3-D OCT, morphologic changes in the jailed side-branch ostium were evaluated before and after a single stent crossover at coronary bifurcation lesions.


METHODS
In 109 patients who received a single stent crossover at coronary bifurcation lesions, the minimal lumen area (MLA) before and after intervention and the eccentricity of the jailed side-branch ostium were measured with 3-D OCT. The eccentricity index was defined as the ratio of maximal diameter/minimal diameter of the jailed side-branch ostium. When the eccentricity index was < 1.5, the shape of the jailed side-branch ostium was defined as circular. The MLA of the jailed side-branch ostium was also calculated from the quantitative coronary angiography (QCA) minimal lumen diameter assuming a circular lumen.


RESULTS
The 3-D OCT-measured MLA of the jailed side-branch ostium decreased from 2.91 ± 1.65 mm(2) before intervention to 2.37 ± 1.48 mm(2) after intervention (P < 0.01). The QCA-derived MLA also decreased from 2.35 ± 1.71 mm(2) before intervention to 1.68 ± 1.56 mm(2) after intervention (P < 0.01). However, the 3-D OCT-measured MLA was significantly larger than the QCA-derived MLA (P < 0.01). The shape of the jailed side-branch ostium changed from circular to elliptical after the stent implantation (eccentricity index: 1.40 ± 0.33 before intervention; 1.71 ± 0.60 after intervention; P < 0.01).


CONCLUSIONS
Compared with QCA measurements, 3-D OCT analysis could be useful to guide decisions regarding additional intervention after stent implantation across coronary bifurcation lesions.
Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea.
Sungsoo
S
Cho
Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea; Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea.
Jung-Sun
JS
Kim
Department of Optical Engineering, Sejong University, Seoul, Korea.
Jinyong
J
Ha
Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea; Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea.
Dong-Ho
DH
Shin
Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea; Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea.
Byeong-Keuk
BK
Kim
Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea; Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea.
Young-Guk
YG
Ko
Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea; Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea.
Donghoon
D
Choi
Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea; Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea; Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, Korea.
Yangsoo
Y
Jang
Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea; Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea; Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, Korea. Electronic address: mkhong61@yuhs.ac.
Myeong-Ki
MK
Hong
D017023:Coronary Angiography; D023921:Coronary Stenosis / Q000175:diagnosis* / Q000503:physiopathology / Q000601:surgery; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D053805:Fractional Flow Reserve, Myocardial; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization / Q000379:methods; D012189:Retrospective Studies; D012720:Severity of Illness Index; D015607:Stents; D041623:Tomography, Optical Coherence / Q000379:methods*