Immediate results of bifurcational stenting assessed with optical coherence tomography |
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Authors: | Nicola Viceconte MD Pawel Tyczynski MD PhD Giuseppe Ferrante MD PhD Nicolas Foin PhD Pak Hei Chan MD Eduardo Alegrìa Barrero MD Carlo Di Mario MD PhD FESC |
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Institution: | 1. Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, , London, United Kingdom;2. Heart and Great Vessels Department, La Sapienza University, , Rome, Italy;3. Imperial College, , London, United Kingdom |
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Abstract: | Background : A tubular stent may adapt with difficulty to coronary bifurcation lesions (CBLs). Methods : Time domain or frequency domain (FD) optical coherence tomography (OCT) was performed to assess strut apposition immediately after stent implantation across four segments inside the bifurcation, in a consecutive series of patients. OCT pullbacks were performed in the main vessel (MV). Results : A total of 13,142 struts in 45 CBL in 41 patients were assessed. Strut malapposition was significantly more frequent in the half bifurcation facing the side‐branch (SB) ostium (42.9%) than in the proximal segment of the bifurcation 11.8%, half bifurcation opposite the SB 6.7%, or the distal segment 5.7% (all P < 0.0001). Lesions (n = 15) treated with stenting of both MV and SB had a total higher rate of malapposition than those (n = 30) treated with stenting of the MV only (17.6% vs. 9.5%; P = 0.0014). In latter group, lesions treated with FD‐OCT‐guided stent implantation (n = 13) presented a lower rate of malapposition than those treated with conventional angiographic‐guided stent implantation (n = 17) (7.1% vs. 17.5%; P = 0.005). Conclusions : In CBL, strut malapposition is particularly high at the SB ostium. However, a strategy of stenting MV only with adjunctive FD‐OCT guidance is associated with lower rates of malapposition. © 2012 Wiley Periodicals, Inc. |
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Keywords: | optical coherence tomography bifurcations percutaneous coronary intervention lesion assessment stent optimization |
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