Two-stent techniques for coronary bifurcation lesions (main vessel first versus side branch first): results from the COBIS (COronary BIfurcation Stenting) II registry

Abstract Background Provisional side branch (SB) stenting is correlated with target-vessel myocardial infarction (TVMI) in patients with coronary bifurcation lesions. However, the underlying mechanisms remain unknown. Objectives We aimed to determine the correlation of SB lesion length with vulnerable plaques using optical coherence tomography (OCT) and TVMI in patients with coronary bifurcation lesions treated by a provisional approach. Methods A total of 405 patients with 405 bifurcation lesions who underwent pre-PCI OCT imaging of both main vessel (MV) and SB was prospectively enrolled. Patients were defined as Long-SB lesion (SB lesion length ≥10 mm) and Short-SB lesion (SB lesion length <10 mm) groups according to quantitative coronary analysis and were also stratified by the presence of vulnerable plaques based on OCT findings. The primary endpoint was the occurrence of TVMI after provisional stenting at one-year follow-up. Results 178 (43.9%) patients had long SB lesions. Vulnerable plaques predominantly localized in the main vessel (MV) and more frequently in the Long-SB lesion group (42.7%) compared to 24.2% in the Short-SB lesion group (p<0.001). At one-year follow-up after provisional stenting, there were 31 (8.1%) TVMIs, with 11.8% in the Long-SB lesion group and 4.4% in the Short-SB lesion group (p=0.009), leading to significant difference in target lesion failure between two groups (15.2% vs. 6.6%, p=0.007). The rate of cardiac death, revascularization, and stent thrombosis was comparable between study groups. By multivariate regression analysis, long SB lesion length (p=0.011), presence of vulnerable plaques in the polygon of confluence (p=0.001), and true coronary bifurcation lesions (p=0.004) were three independent factors of TVMI. Conclusions Long-SB lesion length with MV vulnerable plaques predict increased TVMI after provisional stenting in patients with true coronary bifurcation lesions. Further study is warranted to identify the better stenting techniques for coronary bifurcation lesions with long lesion in the SB Kaplan-Meier survival curve Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): NSFC

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P757Is it possible to predict fractional flow reserve in side branch after main vessel stenting in coronary bifurcation lesions by means of intracoronary electrocardiogram?

European Heart Journal ◽

10.1093/eurheartj/ehy564.p757 ◽

2018 ◽

Vol 39 (suppl_1) ◽

Author(s):

D V Vassilev ◽

L Dosev ◽

M S Shumkova ◽

K K Karamfiloff ◽

G Z Zlatancheva ◽

...

Keyword(s):

Fractional Flow Reserve ◽

Side Branch ◽

Fractional Flow ◽

Coronary Bifurcation ◽

Coronary Bifurcation Lesions ◽

Flow Reserve ◽

Main Vessel ◽

Bifurcation Lesions

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Analysis of Side Branch Access During Bifurcation Stenting

ASME 2008 Summer Bioengineering Conference, Parts A and B ◽

10.1115/sbc2008-192768 ◽

2008 ◽

Author(s):

Peter Mortier ◽

Matthieu De Beule ◽

Denis Van Loo ◽

Benedict Verhegghe ◽

Pascal Verdonck

Keyword(s):

Side Branch ◽

Local Blood Flow ◽

Coronary Bifurcation ◽

Coronary Bifurcation Lesions ◽

Clinical Literature ◽

Bifurcation Stenting ◽

Common Technique ◽

Flow Through ◽

Bifurcation Lesions ◽

Stenotic Arteries

A common technique to improve the local blood flow through stenotic arteries involves the implantation of a metallic scaffold known as a stent. These devices have shown excellent results in unbranched vessels. However, the treatment of coronary bifurcation lesions remains an enormous challenge and is generally associated with an increased complication rate. Many different techniques have been proposed in clinical literature, but all the suggested methodologies have specific limitations [1]. In many cases, a stent is deployed in the main branch (MB) and logically, this compromises the side branch (SB) patency. This is a frequently encountered situation that can be improved by balloon dilatation through the side of the MB stent (fig. 1). However, such balloon inflation may result in unwanted distortions of the stent [2].

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