Predictors Of Side Branch Occlusion Research Articles

TCTAP A-031 Predictors of Side Branch Occlusion in the Non-Left Main Bifurcation Percutaneous Coronary Intervention

TCTAP A-031 Predictors of Side Branch Occlusion in the Non-Left Main Bifurcation Percutaneous Coronary Intervention

Predictors and complications of side branch occlusion after recanalization of chronic total occlusions complicated with bifurcation lesions

Data on risk factors and periprocedural complications associated with side branch (SB) occlusion after chronic coronary total occlusion (CTO) recanalization are limited. The aims of this study were to identify independent predictors of side branch (SB) occlusion after chronic total occlusion (CTO) recanalization and assess the relationship between SB occlusion and perioperative complications. 245 patients with CTO bifurcation lesions (BFLs) who underwent successful CTO recanalization were included in the study. In the occlusion group, most of the SB occlusions were observed after the implantation of the stents and lack of SB protection was more common. However, there was no significant between-group difference in the angles between the main vessel (MV) and SB. SB occlusion was associated with a higher risk of periprocedural myocardial infarction and a higher composite periprocedural complication rate. Identified as predictors of SB occlusion were no SB protection, use of a dissection-reentry strategy, ostial SB stenosis, and proximal MV stenosis of 50% or more.

Predictors of side branch compromise in calcified bifurcation lesions treated with orbital atherectomy.

The aim of the study was to identify the predictors of side branch (SB) compromise in severely calcified bifurcation lesions treated with orbital atherectomy (OA). SB compromise remains a major complication of bifurcation lesion percutaneous coronary intervention (PCI). Higher prevalence of lipid-rich plaques and spotty calcification by optical coherence tomography (OCT) and SB ostial stenosis by angiography have been previously suggested as predictors of SB occlusion after main vessel (MV) stenting. Patients with chronic stable angina and severely calcified bifurcation lesions, in whom provisional stenting strategy was planned, were enrolled in the study. OA was used for lesion preparation in all cases. OCT imaging of the MV was performed before and after stenting. SB compromise was defined as a composite of SB occlusion (TIMI flow grade ≤ 2) and SB intervention after MV stenting. Thirty stable CAD patients with 30 severely calcified bifurcation lesions were included in the study. Twelve patients (40%) had a compromised SB after MV stenting. Compromised SB was characterized by a greater angiographic diameter stenosis (55.4 ± 8.1% vs. 35.0 ± 14.4%, P < 0.01) and a smaller minimal lumen diameters (0.79 ± 0.17 vs. 1.12 ± 0.30 mm, P = 0.002) before PCI compared to noncompromised SB. The prevalence of OCT lipid-rich plaques was low and did not differ between the groups (18 vs. 19%, P = 0.68). There was no difference in other OCT plaque characteristics including the presence of spotty calcification. The severity of SB ostial disease and not MV plaque morphology contributed to SB compromise in severely calcified bifurcation lesions.

Assessment of Predictors of Side Branch Occlusion after Main Vessel Stenting in Coronary Bifurcation Lesions in Patients Undergoing Percutaneous Coronary Intervention.

To determine the frequency of side branch (SB) occlusion during percutaneous coronary intervention (PCI) with stenting of bifurcation lesions and to assess the predictors of side branch occlusion in local population. Cross-sectional study. Cardiac Catheterization Lab, Rawalpindi Institute of Cardiology, Rawalpindi, from July 2016 to January 2017. A total of 200 patients fulfilling the inclusion criteria were included in the study with non-probability consecutive sampling technique. Variables like diameters and lesion lengths of main vessel and side branch were recorded using quantitative coronary analysis software (QCA). The SB occlusion was defined as <3 TIMI score following main vessel PCI with stenting. The data was analysed using SPSS version 21.0. Mean age (years) of the study population was 52.27 ±13.33 including 180 (90.0%) male and 20 (10.0%) female patients. SB occlusion was observed in 15 (7.5%) of cases. Mean SB diameter was significantly larger in cases without SB occlusion than those with SB occlusion (2.06 ±0.09 vs. 2.17 ±0.26, p=0.003). Similarly, SB lesions were significantly shorter in length in those without SB occlusion than those with SB occlusion (3.53 ±0.51 and 4.66 ±3.11, p<0.001). However, mean MV diameter (mm) and mean MV lesions length (mm) in both the groups were statistically not significant. Mean SB diameter and lesion length are useful predictors of SB occlusion during stenting of bifurcation lesions in the local population.

Understanding the Coronary Bifurcation Stenting.

Coronary bifurcation stenting is still complex and associated with a high risk of stent thrombosis and restenosis even with contemporary techniques. Although provisional approach has been proved to be the standard strategy of treatment, There is still lack of evidences for multiple steps of the procedure. For so many years we have been focused on the optimization of side branch (SB), but the clinical outcome is mostly dependent on the main vessel (MV) stenting. The optimal expansion of MV stent without the compromise of SB is the ultimate goal to achieve in the coronary bifurcation stenting. Understanding the anatomy and physiology of coronary bifurcation lesion should be the most important step to this goal. The relationship of vessel diameter between branches and the anatomical and functional significance of plaque shift and carina shift are two most important concepts to understand. They are the science behind the predictors of SB occlusion, and the rationale of proximal optimization technique and final kissing ballooning. This specific review will be devoted to review those concepts as well as clinical evidences to support them.

Side Branch Occlusion Determinants in Bifurcation Lesions Treated with Provisional Stenting Technique

It is well known that because of turbulence flow and shear stress, bifurcation sites of coronary arteries are vulnerable to atherosclerotic disease. Bifurcation lesions comprise 15% to 20% of all coronary lesions. Bifurcation lesions are treated by either using provisional or double stent technique. The main drawback of provisional stenting is side branch occlusion. We aimed to investigate the predictors of side branch occlusion in provisional stenting technique. We enrolled 803 patients (231 female, 572 male, average age 60.5 ± 12.0) whose bifurcation coronary lesions treated by provisional stenting in Adana Numune Education and Training Centre. Demographic, angiographic and interventional data’s are recorded. 182 patients (22.7%) admitted to hospital with stable angina and 621 (77.3%) with acute coronary syndrome (or unstable angina). 582 (72.5%) patients had left anterior descending artery, 166 (20.7%), circumflex and 55 (6.8%) right coronary artery as the culprit vessel. Side branch occlusion occurred in 52 patients (6.5%). Need for side branch intervention occurred in 160 patients. The predictors of need for side branch intervention were, multivessel disease, type of main branch stent, oversize of stent, presence of side branch disease before intervention, TIMI frame count (TFC) and the alpha angle. In conclusion multivessel disease, type of main branch stent, oversize of stent, presence of side branch disease before intervention, TIMI frame count (TFC) and the alpha angle were independent predictors of need for side branch intervention.

Plaque morphology predictors of side branch occlusion after provisional stenting in coronary bifurcation lesion: Results of optical coherence tomography bifurcation study (ORBID).

The aim of this study was to identify the predictors of side branch (SB) ostial stenosis developed after provisional stenting of the main vessel (MV) using optical coherence tomography (OCT). Provisional stenting remains the main approach to treatment of bifurcation lesions; however, it may result in the narrowing of SB ostium. There is little information about underlying plaque morphology of the MV lesion and its potential impact on the SB after provisional stenting. Patients with stable coronary disease with angiographic MV lesion not involving SB were included in a prospective single center study. The primary outcome was significant SB ostium stenosis (SBOS), defined as residual stenosis of >50% after MV stenting. Thirty bifurcation lesions in 30 patients were analyzed in the study. Poststenting significant SBOS was observed in 30% of patients. The MV lesions with SBOS > 50% were characterized by a higher prevalence of lipid rich plaques (100 vs. 64%, p=0.040) and spotty calcifications (60 vs. 0%, p=0.005). Maximal lipid arcs were greater (257° vs. 132°, p=0.001) and lipid volume index was higher (1380 vs. 574, p=0.012) in the SBOS >50% group. Multivariate logistic regression analysis identified maximal lipid arc (odds ratio (OR): 1.014, p=0.038) and the presence of lipid plaque contralateral to SB ostium (OR: 8.14, p=0.046) before stenting as independent predictors of significant SBOS after PCI. High lipid content of the MV lesion and a contralateral location of lipid in the bifurcation area may contribute to SBOS after provisional stenting. © 2016 Wiley Periodicals, Inc.

Patency of coronary side branches covered by an everolimus-eluting bioresorbable vascular scaffold: clinical outcomes and computed tomography scan follow-up.

The behaviour of side branches (SBs) covered by a bioresorbable vascular scaffold (BVS) is not well known. This study analysed the rate of side branch occlusion (SBO) immediately after BVS implantation, its clinical impact, predictors of SBO and the fate of such SBs at follow-up. We assessed 140 patients with 346 jeopardised SBs divided into three groups: small (<1 mm, n=181), intermediate (1-2 mm, n=102) and large (>2 mm, n=63). SBO was defined as a TIMI flow 0 or 1. Computed tomography was scheduled at six months for patients with jailed SBs >1 mm. Immediate occlusion occurred in 31 (9%) SBs: 22 (12%) small, 8 (8%) intermediate and one (1.6%) large, while post-procedural SBO was 5.5%. In-hospital events included one thrombosis (0.7%) and eight non-Q-wave myocardial infarctions (6%). After 17±3 months, one patient died (0.7%) and six patients needed repeat revascularisation (4%). Re-evaluation showed no late SBO at 7±3 months. Predictors of SBO were: small SBs (OR 2.06, 95% CI: 1.08-4.63; p<0.05) and stenosis >50% at the origin (OR 17.22, 95% CI: 7.79-38.10; p<0.01). The incidence of SBO and its clinical impact were low when SBs >1 mm were covered. These favourable results were maintained at midterm.

Predictors of side branch occlusion in bifurcation lesions after percutaneous coronary intervention: a coronary computed tomography angiography with 64-slice multidetector computed tomography study

Predictors of side branch occlusion in bifurcation lesions after percutaneous coronary intervention: a coronary computed tomography angiography with 64-slice multidetector computed tomography study

Intravascular Ultrasound Predictors of Side Branch Occlusion in Bifurcation Lesions After Percutaneous Coronary Intervention

Percutaneous coronary intervention (PCI) of bifurcation lesion has been associated with a low success rate and a high incidence of procedural complications, including side branch occlusion and myocardial infarction. It remains controversial whether preintervention intravascular ultrasound (IVUS) findings can help to identify side branches likely to occlude after PCI of bifurcation lesions. From our IVUS database we identified 81 bifurcation lesions in 72 patients. Side branches were classified into 2 groups: group 1 had ostial side branch stenosis due to atherosclerotic plaque only in the main vessel (n=61), and group 2 had plaque truly involved in the side branch ostium (n=20). There was no significant difference between the 2 groups in the extent of ostial stenosis as assessed by angiography. After PCI, 7 side branches occluded in group 2, compared with 5 side branches occluded in group 1 (35% vs 8%, p=0.003). Ostial plaque distribution as assessed by IVUS may be one of the consistent predictors of side branch occlusion after PCI.

Short- and long-term outcomes of compromised side branches after Multi-Link stent implantation.

The Multi-Link stent is superior to other stents in terms of low rates of restenosis and target vessel revascularization. However, few data exist regarding short- and long-term outcomes for side branches after stenting. We evaluated short and long clinical outcomes and angiographic predictors of side-branch occlusion after the deployment of 137 Multi-Link stents. Thirty-four (25%) of the 137 side branches occluded immediately after stenting. We attempted reangioplasty for the side branches and our success rate was 85%. The incidence of side branches with intrinsic ostial disease was more than 50% before stenting and origination from the stented midsegment was a powerful angiographic predictor of side-branch occlusion. Side-branch patency is well maintained long-term. The incidence of restenosis within and near the stented segment of the parent vessel was 19%, and the incidence of target vessel revascularization was 15%. We recommend the use of Multi-Link stents regardless of the presence of side branches in the vicinity of the stenosis.

Predictors of Side Branch Occlusion Immediately after Coronary Stenting: an Intravascular Ultrasound Study

Background and Objectives:Previous studies have indicated that side branch occlusion (SBO) remains a significant problem in coronary bifurcation lesions during percutaneous intervention. Subjects and Methods: To evaluate the predictors of SBO by intravascular ultrasound (IVUS), 35 patients (28 males, mean age 56± 11 years) were studied at their left anterior descending artery (LAD)-diagonal branch (DB) bifurcation lesions, prior to coronary intervention for the measurement of the following plaque characteristics:total plaque area (PA), PA of the branch-side semicircle, % area stenosis (%AS) of the LAD, the presence of bull’s eye in the DB, the diameter of the vessel and the ostial lumen of the DB, and the LAD-DB angle. SBO was defined as a persistant reduction in the TIMI flow to ≤1 by the end of the procedure. Results:The PA of the branch-side semicircle, the vessel diameter and the ostial lumen diameter of the DB all significantly affected the SBO. The total PA and the %AS of the LAD were not related to the SBO. Multivariate analysis identified that the PA of the branch-side semicircle was the only predictor of SBO (odds ratio 3.2, 95% confidence interval 1.3 to 8.6, p=0.015). Conclusion:It appears that the plaque distribution of LAD is a major determinant of SBO. These findings support the theory that the plaque shift (“snow plow effect”) may be the mechanism of the SBO following stenting. (Korean Circulation J 2002;32(8):655-665)

Predictors of side branch occlusion immediately after coronary stenting, an intravascular ultrasound study So-Yeon Choi, Seung-Jea Tahk, Han-Soo Kim, Zhe-Xun Lian, Myeong-Ho Yoon, Sang Yong Yoo, Sung-Gyun Ahn, Hyuk-Jae Chang, Gyo-Seung Hwang, Joon-Han Shin, Byung-il W. Choi. Ajou University, Suwon, South Korea

Predictors of side branch occlusion immediately after coronary stenting, an intravascular ultrasound study So-Yeon Choi, Seung-Jea Tahk, Han-Soo Kim, Zhe-Xun Lian, Myeong-Ho Yoon, Sang Yong Yoo, Sung-Gyun Ahn, Hyuk-Jae Chang, Gyo-Seung Hwang, Joon-Han Shin, Byung-il W. Choi. Ajou University, Suwon, South Korea

Incidence and angiographic predictors of side branch occlusion following high-pressure intracoronary stenting

We evaluated the incidence, angiographic predictors, and clinical outcome of side branch occlusion (SBO) following high-pressure intracoronary stenting in 175 patients. All stent implants during a 7-month period were reviewed for the incidence of major (>1 mm) SBO. Side branches were further characterized based on side branch and index lesion morphology. Clinical events (death, myocardial infarction, and target vessel revascularization rates) were determined at 9 months. A total of 175 patients (182 lesions) had 224 major side branches covered by intracoronary stents. Of these, 43 (19%) occluded. Most SBOs (29 of 43 [67%]) occurred after poststent dilation using high-pressure inflations (15.3 ± 3.3 atmospheres). No clinical characteristics correlated with SBO. By multivariate analysis, those side branches with >50% ostial narrowing that arose from within or just beyond the diseased portion of the parent vessel (threatened side branch morphologies) were a powerful angiographic predictor of SBO (odds ratio 40, 95% confidence interval, 14 to 130, p < 0.0001). At 9-month follow-up there was no difference in combined clinical events between those patients with and without SBO. These data demonstrate that side branches with ostial stenoses in continuity with diseased parent lesions were at risk of occlusion following stenting. SBO, however, was not associated with adverse clinical outcome. These findings lend support to plaque shift (“snow plow effect”) as the mechanism behind SBO following stent placement.