Preintervention Angiographic and Intravascular Ultrasound Predictors for Side Branch Compromise After a Single-Stent Crossover Technique

Abstract

A single stent crossover technique is the most common approach to treating bifurcation lesions. In 90 bifurcation lesions with side branch (SB) angiographic diameter stenosis <75%, we assessed preintervention intravascular ultrasound (IVUS; of main branch [MB] and SB) predictors for SB compromise (fractional flow reserve [FFR] <0.80) after a single stent crossover. Minimal lumen area (MLA) was measured within each of 4 segments (MB just distal to the carina, polygon of confluence, MB just proximal to polygon of confluence, and SB ostium). All lesions showed Thrombolysis In Myocardial Infarction grade 3 flow in the SB after MB stenting. Although angiographic diameter stenosis at the SB ostium increased from 26 ± 15% before the procedure to 36 ± 21% after stenting (p = 0.001), FFR <0.80 was observed in only 16 patients (18%). Negative remodeling (remodeling index <1) was seen in 83 (92%) lesions but did not correlate with FFR after stenting. Independent predictors for FFR after stenting were maximal balloon pressure (p = 0.002) and MLA of SB ostium before percutaneous coronary intervention (p <0.001), MLA within the MB just distal to the carina (p = 0.025), and plaque burden at the SB ostium before percutaneous coronary intervention (p = 0.005), but not angiographic poststenting diameter stenosis or minimal lumen diameter. For prediction of FFR <0.80 after percutaneous coronary intervention, the best cutoff of MLA within the SB ostium before percutaneous coronary intervention was 2.4 mm(2) (sensitivity 94%, specificity 69%). Also, the cutoff of plaque burden within the SB ostium before percutaneous coronary intervention was ≥51% (sensitivity 75%, specificity 71%). In 67 lesions with an MLA ≥2.4 mm(2) or plaque burden <50% before percutaneous coronary intervention, 63 (94%) showed FFR ≥0.80. However, FFR <0.80 was seen in only 12 (52%) of 23 lesions with an MLA <2.4 mm(2) and plaque burden ≥50%. In conclusion, there do not appear to be reliable IVUS predictors of functional SB compromise after crossover stenting.