Abstract 12934: Stent Design Affects the Side Branch Orifice Area Following Coronary Bifurcation Stenting: Comparison Between Resolute Integrity versus Xience V Stent Using a Newly Developed OCT algorithm

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Introduction: Bifurcation lesions remain a challenge in interventional cardiology. Preservation of side branch (SB) orifice may be affected by plaque distribution, SB orifice geometry, and stent design. We compared the open areas of a SB for the two widely used drug-eluting stents, Resolute Integrity (ZES) and Xience V (EES), using a newly developed OCT algorithm. Methods: From our registry database, we identified 123 consecutive cases with bifurcation (SB diameter ≥2.0mm) treated with ZES or EES. Among them, 88 de novo cases (ZES n=46, EES n=42) treated with a single stent were included in the final analysis. In collaboration with MIT, a new algorithm was developed to reconstruct the en face view from raw OCT data to evaluate the SB orifice accurately. Using this new algorithm the SB orifice area (A) and the area obstructed by struts (B) were calculated. The study endpoint was the percent open area defined as (A-B) / A*100. Results: Of 88 cases, 31 (14 ZES and 17 EES) cases were treated with SB dilatation and 57 (32 ZES and 25 EES) cases were treated with crossover stenting without SB dilatation. In those cases with SB dilatation, the %open area was not significantly different between ZES and EES (median, 91.4% vs 89.0%, P=0.33). However, the %open area was significantly smaller in ZES than in EES (median, 84.3% vs 89.2%, P=0.04) in crossover stenting. Multivariate analysis showed that the use of ZES was an independent predictor for the smaller %open area (below median, odds ratio 4.38, P=0.03) in crossover stenting. Conclusions: Using this newly developed algorithm to reconstruct OCT image en face, we demonstrated that the %open area was significantly smaller in Resolute Integrity than that in Xience V in crossover stenting, whereas no significant difference was seen between the two stents after SB dilatation. This finding indicates that stent design affects the SB open area and post dilatation may be important after Resolute Integrity stent implantation.