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Potential Predictors of Side-Branch Occlusion in Bifurcation Lesions after Percutaneous Coronary Intervention: A Coronary CT Angiography Study

医学 经皮冠状动脉介入治疗 闭塞 狭窄 支架 放射科 血管造影 管腔(解剖学) 心脏病学 核医学 心肌梗塞 内科学
作者
Jin Joo Park,Eun Ju Chun,Young‐Seok Cho,Il‐Young Oh,Chang‐Hwan Yoon,Jung‐Won Suh,Sang Il Choi,Tae‐Jin Youn,Bon‐Kwon Koo,In‐Ho Chae,Dong‐Ju Choi
出处
期刊:Radiology [Radiological Society of North America]
卷期号:271 (3): 711-720 被引量:26
标识
DOI:10.1148/radiol.14131959
摘要

To identify potential predictors of side-branch occlusion after main-vessel (artery) stent implantation in bifurcation lesions by using coronary computed tomography (CT) angiography.This retrospective study was approved by the institutional review board; informed consent was waived. Sixty-five patients with de novo bifurcation lesions underwent coronary CT angiography before percutaneous coronary intervention. By defining side-branch occlusion as Thrombolysis in Myocardial Infarction flow grade 2 or lower, coronary CT angiography plaque characteristics associated with side-branch occlusion (ie, plaque morphology and composition) were analyzed. A multiple logistic regression analysis was undertaken to determine independent potential predictors of side-branch occlusion.Of 65 patients enrolled, 12 patients (18%) had side-branch occlusion after main-vessel stent implantation. Patients with side-branch occlusion had larger mean plaque thickness in the side-branch side of the proximal main vessel (2.29 mm ± 1.87 [standard deviation] vs 1.29 mm ± 1.43, P = .043), larger plaque thickness in the noncarinal side of the side branch (1.43 mm ± 1.18 vs 0.51 mm ± 0.65, P < .001), smaller side-branch lumen diameter (1.24 mm ± 0.74 vs 1.87 mm ± 0.71, P = .007), and higher diameter stenosis (50.9% ± 24.0 vs 25.5% ± 25.3, P = .002) compared with those without side-branch occlusion. The cutoff value of proximal main vessel plaque thickness was 2.7 mm (area under the curve [AUC], 0.67; 95% confidence interval [CI]: 0.48, 0.86) and of side-branch-diameter stenosis was 40% (AUC, 0.79; 95% CI: 0.67, 0.92). Lesions with plaque thickness in proximal main vessel greater than 2.7 mm and side-branch-diameter stenosis greater than 40% were associated with a 5.6-fold and 6.2-fold, respectively, increased risk of side-branch occlusion.Potential coronary CT angiography predictors of side-branch occlusion in bifurcation lesions are plaque thickness in the side-branch side of the proximal main vessel, plaque thickness in the noncarinal side of the side branch, side-branch lumen diameter, and side-branch-diameter stenosis. These potential predictors might guide operators planning the optimal strategy for treating bifurcation lesions.
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