Int J Angiol 2019; 28(02): 137-141
DOI: 10.1055/s-0038-1676042
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Carina Bifurcation Angle and Side Branch Occlusion in Coronary Bifurcation Lesions Intervention: Angiographic Lesions Characteristic Role in Determining Its Relation

Bogie Putra Palinggi
1   Department of Cardiology and Vascular Medicine, Harapan Kita National Cardiovascular Center, Faculty of Medicine University of Indonesia, Jakarta, Indonesia
,
Doni Firman
1   Department of Cardiology and Vascular Medicine, Harapan Kita National Cardiovascular Center, Faculty of Medicine University of Indonesia, Jakarta, Indonesia
› Author Affiliations
Further Information

Publication History

Publication Date:
29 November 2018 (online)

Abstract

Side branch occlusion has been implicated as a complication after percutaneous coronary intervention in coronary bifurcation lesions. The role of carina bifurcation angle as one of the characteristics of the coronary bifurcation lesions in causing side branch occlusion after percutaneous coronary intervention is still debated. This study aims to assess the correlation between carina bifurcation angles as one of the characteristics of the coronary bifurcation lesions and side branch occlusion in elective percutaneous coronary intervention. This is a cross-sectional study which utilizes CAAS 5.1 software to measure carina bifurcation angle. We collected 113 lesions in 108 patients that met the inclusion criteria from January 2016 to October 2016. Side branch occlusion occurred in 15 lesions (13.3%), with median carina bifurcation angle 19.17 degrees (p < 0.001). Multivariate analysis showed there is a correlation between carina bifurcation angle with side branch occlusion, OR (odds ratio) 0.86 (95% CI [confidence interval]: 0.80–0.92) with ≤ 33.71 degrees cut off value. Increased risk of side branch occlusion was found in small carina bifurcation angle.

 
  • References

  • 1 Dou K, Zhang D, Xu B. , et al. An angiographic tool for risk prediction of side branch occlusion in coronary bifurcation intervention: the RESOLVE score system (Risk prEdiction of Side branch OccLusion in coronary bifurcation interVEntion). JACC Cardiovasc Interv 2015; 8 (1, Pt A) 39-46
  • 2 Muramatsu T, Onuma Y, García-García HM. , et al; ABSORB-EXTEND Investigators Incidence and short-term clinical outcomes of small side branch occlusion after implantation of an everolimus-eluting bioresorbable vascular scaffold: an interim report of 435 patients in the ABSORB-EXTEND single-arm trial in comparison with an everolimus-eluting metallic stent in the SPIRIT first and II trials. JACC Cardiovasc Interv 2013; 6 (03) 247-257
  • 3 Alfonso F, Hernández C, Pérez-Vizcayno MJ. , et al. Fate of stent-related side branches after coronary intervention in patients with in-stent restenosis. J Am Coll Cardiol 2000; 36 (05) 1549-1556
  • 4 Gwon HC, Song YB, Pan M. The story of plaque shift and carina shift. EuroIntervention 2015; 11 (Suppl V): V75-V77
  • 5 Gil RJ, Vassilev D, Formuszewicz R, Rusicka-Piekarz T, Doganov A. The carina angle-new geometrical parameter associated with periprocedural side branch compromise and the long-term results in coronary bifurcation lesions with main vessel stenting only. J Interv Cardiol 2009; 22 (06) E1-E10
  • 6 Vassilev D, Alexandrov A, Le D. , et al. Importance of bifurcation angle in bifurcation stenting. Chin Med J (Engl) 2012; 125 (22) 4122-4125
  • 7 Xu J, Hahn JY, Song YB. , et al. Carina shift versus plaque shift for aggravation of side branch ostial stenosis in bifurcation lesions: volumetric intravascular ultrasound analysis of both branches. Circ Cardiovasc Interv 2012; 5 (05) 657-662
  • 8 Chen HY, Moussa ID, Davidson C, Kassab GS. Impact of main branch stenting on endothelial shear stress: role of side branch diameter, angle and lesion. J R Soc Interface 2012; 9 (71) 1187-1193
  • 9 Zhang D, Xu B, Yin D. , et al. Clinical and angiographic predictors of major side branch occlusion after main vessel stenting in coronary bifurcation lesions. Chin Med J (Engl) 2015; 128 (11) 1471-1478
  • 10 Popma JJ, Mauri L, O'Shaughnessy C. , et al. Frequency and clinical consequences associated with sidebranch occlusion during stent implantation using zotarolimus-eluting and paclitaxel-eluting coronary stents. Circ Cardiovasc Interv 2009; 2 (02) 133-139
  • 11 Nakazawa G, Yazdani SK, Finn AV, Vorpahl M, Kolodgie FD, Virmani R. Pathological findings at bifurcation lesions: the impact of flow distribution on atherosclerosis and arterial healing after stent implantation. J Am Coll Cardiol 2010; 55 (16) 1679-1687
  • 12 Vassilev D, Gil RJ. Relative dependence of diameters of branches in coronary bifurcations after stent implantation in main vessel--importance of carina position. Kardiol Pol 2008; 66 (04) 371-378 , discussion 379
  • 13 Koo BK, Waseda K, Kang HJ. , et al. Anatomic and functional evaluation of bifurcation lesions undergoing percutaneous coronary intervention. Circ Cardiovasc Interv 2010; 3 (02) 113-119
  • 14 Medina A, Martín P, Suárez de Lezo J. , et al. Vulnerable carina anatomy and ostial lesions in the left anterior descending coronary artery after floating-stent treatment. Rev Esp Cardiol 2009; 62 (11) 1240-1249
  • 15 Nakamura S, Hall P, Maiello L, Colombo A. Techniques for Palmaz-Schatz stent deployment in lesions with a large side branch. Cathet Cardiovasc Diagn 1995; 34 (04) 353-361
  • 16 Aliabadi D, Tilli FV, Bowers TR. , et al. Incidence and angiographic predictors of side branch occlusion following high-pressure intracoronary stenting. Am J Cardiol 1997; 80 (08) 994-997
  • 17 Fischman DL, Savage MP, Leon MB. , et al. Fate of lesion-related side branches after coronary artery stenting. J Am Coll Cardiol 1993; 22 (06) 1641-1646
  • 18 Ghayemian A, Nozari Y, Safir M, Mohammadpour RA. Predictors of side branch occlusion and its early complication after angioplasty in bifurcation lesions. Pak J Med Sci 2008; 24 (03) 430-435