Background:
Stent implantation for coronary bifurcation is intrinsically accompanied with inappropriate strut apposition around side branch (SB), which has potential risk for future development of stent thrombosis. Previous experimental studies indicated that side branch angle (SBA) influences the local flow turbulence and wall shear stress. The purpose of this study was to investigate the relation between SBA and the neointimal coverage of drug-eluting stent (DES) which were implanted in coronary bifurcation lesions.
Methods:
Forty-seven bifurcation lesions treated with DES were evaluated with FD-OCT in 39 patients (mean age; 65.7±13.9 y.o) at follow-up angiography. Each lesions were divided into the bifurcation lesions without kissing balloon technique (KBT) after stent implantation (non-KBT group; 28 lesions) and those with KBT (KBT group; 19 lesions). Neointimal coverage was assessed based on cross-sectional OCT images containing SB at 0.4mm interval, and separately evaluated in terms of jailing struts over the SB ostium (SO) and non-jailing struts attaching to the vessel wall (VW). BA was measured on the longitudinal reconstruction images of FD-OCT before stent implantation. Incidence of uncovered struts and neointimal thickness were measured.
Results:
In non-KBT group, the percentage of uncovered struts was significantly higher in lesions with SBA≦60°compared with those with SBA>60°at both SO and VW region (56.9±39.8% vs. 25.6±26.8%, p<0.05; 10.6±7.6% vs. 3.3±4.4%, p<0.01, respectively) and significant negative correlation was found between SBA and the percentage uncovered struts at both SO and VW regions (r=–0.55, p<0.01; r=–0.47, p<0.05, respectively). In KBT group, the percentage of uncovered struts was not significant difference between lesions with SBA≦60°and those with SBA>60°at both SO and VW region (36.7±35.3% vs. 36.6±34.8%; 10.9±10.4% vs. 8.6±12.7%, respectively) and no correlation was found between SBA and the percentage of uncovered struts at both SO and VW region.
Conclusions:
The neointimal coverage of DES was affected by in bifurcation lesion without KBT, but is not affected in bifurcation lesion with KBT. KBT has potential benefit for neointimal coverage of DES at coronary bifurcation lesion with narrow SBA.
Clinical outcomes of patients undergoing rotational atherectomy followed by drug-eluting stent implantation: A single-center real-world experience
