CLINICAL RESEARCH: INTERVENTIONAL CARDIOLOGY
Serial Intravascular Ultrasound Analysis of the Main and Side Branches in Bifurcation Lesions Treated With the T-Stenting Technique
Joo-Yong Hahn, MD, PhD,
Young Bin Song, MD,
Sang-Yup Lee, MD,
Jin-Ho Choi, MD, PhD,
Seung-Hyuk Choi, MD, PhD,
Duk Kyung Kim, MD, PhD,
Sang Hoon Lee, MD, PhD and
Hyeon-Cheol Gwon, MD, PhD*
Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
Manuscript received November 13, 2008;
revised manuscript received March 4, 2009,
accepted March 10, 2009.
* Reprint requests and correspondence: Dr. Hyeon-Cheol Gwon, Cardiac and Vascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul, 135-710, Republic of Korea (Email: hcgwon{at}skku.edu).
Objectives: This study sought to investigate the mechanism of restenosis and the predictive value of post-procedural minimum stent area (MSA) in the side branch (SB) after coronary bifurcation stenting.
Background: The mechanism of restenosis, especially at the SB ostium, has not been fully elucidated.
Methods: This study examined 73 bifurcation lesions with post-procedural and 9-month follow-up intravascular ultrasound images for both main vessel (MV) and SB. All lesions were treated with drug-eluting stents using the T-stenting technique. Analysis included 5 distinct locations: MV proximal stent, MV middle area, MV distal stent, SB ostium (<5 mm distal to the neocarina), and SB distal stent.
Results: Stent expansion was significantly less in the SB than in the MV (87.1 ± 20.4% vs. 97.0 ± 29.1%, p = 0.007). The SB ostium was the most frequent site of post-procedural MSA. At the SB ostium, follow-up minimum lumen area (MLA) correlated with post-procedural MSA (r = 0.81, p < 0.001). The percentage of neointimal area was higher at the SB ostium than at the MV proximal, MV distal, and SB distal stent (23.8 ± 18.9% vs. 13.3 ± 17.3%, 15.4 ± 20.5%, and 12.5 ± 17.2%, p < 0.001). The optimal threshold of post-procedural MSA to predict follow-up MLA  4 mm2 at the SB ostium was 4.83 mm2, yielding an area under the curve of 0.88 (95% confidence interval: 0.80 to 0.95).
Conclusions: Our data suggest that inadequate post-procedural MSA with increased neointimal hyperplasia may cause the SB ostium to be the most frequent site of restenosis after percutaneous coronary intervention on bifurcation lesions.
Key Words: coronary disease • bifurcation • restenosis • ultrasonic
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Abbreviations and Acronyms
| | DES = drug-eluting stent(s) | | IVUS = intravascular ultrasound | | MLA = minimum luminal area | | MLD = minimum luminal diameter | | MSA = minimum stent area | | MV = main vessel | | PCI = percutaneous coronary intervention | | QCA = quantitative coronary angiography | | RD = reference diameter | | SB = side branch |
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J. Am. Coll. Cardiol. 2009 54: A24.
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