Interventional Cardiology

Abstract

side branch (SB) occlusion occurs in 20% of cases. The plaque characteristics associated with SB occlusion after main vessel (MV) stent implantation are not known. We sought to identify the predictors of SB occlusion after MV stent implantation in bifurcation lesions using coronary computed tomography angiography (CCTA). Methods: Patients with de novo bifurcation lesions underwent CCTA before PCI. By defining SB occlusion as TIMI flow grade ≤2, we analyzed the CCTA plaque characteristics associated with SB occlusion. Results: Sixty-five patients were enrolled, and 12 patients (18%) had SB occlusion after MV stent implantation. Patients with SB occlusion had larger plaque thickness in the SB-side of the proximal MV (2.29±1.87 vs. 1.29±1.43 mm, p=0.043), larger plaque thickness in the non-carinal side of the SB ostium (1.43±1.18 vs. 0.51±0.65 mm, p=0.001), smaller lumen diameter in the SB ostium (1.24±0.74 vs. 1.87±0.71 mm, p=0.007), and higher diameter stenosis in the SB ostium (50.9±24.0% vs. 25.5±25.3%, p=0.002) compared with those without SB occlusion. The cutoff value of proximal MV plaque thickness was 2.69 mm (area under the curve [AUC], 0.67; 95% confidence interval [CI], 0.48–0.86), and of SB ostial diameter stenosis was 43% (AUC, 0.79; 95% CI, 0.67–0.92). Lesions with plaque thickness in proximal MV >2.69 mm and SB ostial diameter stenosis >43% were associated with a 5-fold and 7-fold increased risk of SB occlusion, respectively. Conclusions: CCTA predictors of SB occlusion in bifurcation lesions are plaque thickness in the SB-side of the proximal MV, plaque thickness in the non-carinal side of the SB ostium, SB ostial lumen diameter and SB ostial diameter stenosis. These predictors might guide operators planning the optimal strategy for treating bifurcation lesions.