Conflict of interest: Grant to the Institution provided by Medtronic (RESOLUTE III trial), Abbott (EXCEL trial), Biosensors (LEADERS Allcomers and OCT substudies). St Jude LightLab sponsored live transmissions from the Royal Brompton.
Coronary Artery Disease
Immediate results of bifurcational stenting assessed with optical coherence tomography
Article first published online: 28 SEP 2012
Copyright © 2012 Wiley Periodicals, Inc.
Catheterization and Cardiovascular Interventions
Volume 81, Issue 3, pages 519–528, February 2013
How to Cite
Viceconte, N., Tyczynski, P., Ferrante, G., Foin, N., Chan, P. H., Barrero, E. A. and Di Mario, C. (2013), Immediate results of bifurcational stenting assessed with optical coherence tomography. Cathet. Cardiovasc. Intervent., 81: 519–528. doi: 10.1002/ccd.24337
- Issue published online: 18 FEB 2013
- Article first published online: 28 SEP 2012
- Manuscript Accepted: 3 JAN 2012
- Manuscript Received: 28 JUL 2011
- optical coherence tomography;
- percutaneous coronary intervention;
- lesion assessment;
- stent optimization
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.