Abstract
To investigate the characteristics of coronary artery bifurcation type (parallel or perpendicular type) using three-dimensional (3D) optical coherence tomography (OCT), and determine the feasibility, reproducibility, assessment time and correlation with bifurcation angles measured by 3D quantitative coronary angiography (QCA). We evaluated 60 lesions at the coronary bifurcation that were treated by main vessel (MV) stenting with kissing balloon inflation (KBI) under OCT/optical frequency domain imaging (OFDI) guidance. Inter- and intra-observer agreement regarding the assessment of 3D bifurcation types were 0.88 and 0.94, respectively. The assessment times of 3D-OCT bifurcation type with OCT and OFDI were within about 30 seconds. 3D-OCT bifurcation types showed the greatest correlation with the distal bifurcation angle assessed by 3D-QCA among the three bifurcation angles (distal bifurcation angle, proximal bifurcation angle and main vessel angle), and the optimal cut-off distal bifurcation angle to predict a perpendicular type bifurcation, as determined by ROC analysis, was 51.0° (AUC 0.773, sensitivity 0.80, specificity 0.67). Based on this cut-off value for the distal bifurcation angle (51°), the diagnostic accuracy for perpendicular type bifurcation in cases with a BA ≥ 51° (n = 34) was 70.6% (24/34) and that of the parallel type bifurcation in cases of BA < 51° (n = 26) was 76.9% (20/26). Performing 3D-OCT for assessment of coronary artery bifurcation type is feasible and simple, and can be done in a short time with high reproducibility.
Highlights
Coronary bifurcation lesions account for 15%– 20% of percutaneous coronary interventions (PCI) and remain one of the most challenging situations in interventional cardiology in terms of procedural success rates and long-term cardiac events [1]
Bifurcation angle (BA) can be measured by quantitative coronary angiography (QCA), the accuracy of BA derived from two-dimensional (2D) QCA is limited because of overlapping of branches and vessel foreshortening
The distal BA was defined as the angle between the distal main branch and side branch, the proximal BA was defined as the angle between the proximal main vessel (MV) and SB, and the MV angle was defined as the angle between the proximal MV and distal main branch [8, 15]
Summary
Coronary bifurcation lesions account for 15%– 20% of percutaneous coronary interventions (PCI) and remain one of the most challenging situations in interventional cardiology in terms of procedural success rates and long-term cardiac events [1]. Three-dimensional reconstruction using OCT pullback facilitates understanding of interactions between stents and vessel walls [12]. Bifurcation type, whether perpendicular or parallel, as determined by 3D-OCT, was introduced as a parameter for visually assessing bifurcation appearance and was found to be associated with the incidence of incomplete stent apposition (ISA) at the side branch (SB) ostium after bifurcation PCI [13, 14]. The characteristics of bifurcation type on 3D-OCT are not well known. We investigated the characteristics of 3D-OCT bifurcation type to determine its feasibility, reproducibility, assessment time and correlation with respect to the 3D-QCA bifurcation angle. The correlation between 3D-OCT bifurcation type and ISA at the bifurcation segment after single stenting with kissing balloon inflation (KBI) was evaluated
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