CBS 2019
CBSMD教育中心
中 文

Bifurcation Stenting

Abstract

Recommended Article

The European bifurcation club Left Main Coronary Stent study: a randomized comparison of stepwise provisional vs. systematic dual stenting strategies (EBC MAIN) ‘Small bifurcation?’ CT myocardial mass volume measurements change therapeutic strategy in coronary artery disease Incidence of Adverse Events at 3 Months Versus at 12 Months After Dual Antiplatelet Therapy Cessation in Patients Treated With Thin Stents With Unprotected Left Main or Coronary Bifurcations T and small protrusion (TAP) vs double kissing crush technique: Insights from in-vitro models Effect of Side Branch Predilation in Coronary Bifurcation Stenting With the Provisional Approach - Results From the COBIS (Coronary Bifurcation Stenting) II Registry Double-Kissing Culotte Technique for Coronary Bifurcation Stenting - Technical evaluation and comparison with conventional double stenting techniques In vitro flow and optical coherence tomography comparison of two bailout techniques after failed provisional stenting for bifurcation percutaneous coronary interventions Effect of low-density lipoprotein cholesterol on the geometry of coronary bifurcation lesions and clinical outcomes of coronary interventions in the J-REVERSE registry

Original Research2019 Nov 12. pii: EIJ-D-19-00534.

JOURNAL:EuroIntervention. Article Link

Anatomical Attributes of Clinically Relevant Diagonal Branches in Patients with Left Anterior Descending Coronary Artery Bifurcation Lesions

Jeon WK, Park J, Koo BK et al. Keywords: left anterior descending coronary artery bifurcation lesions; clinical relevance; prediction models

ABSTRACT


AIMS - This study aimed to investigate the anatomical attributes determining myocardial territory of diagonal branches and to develop prediction models for clinically relevant branches using myocardial perfusion imaging (MPI) and coronary CT angiography (CCTA).


METHODS AND RESULTS - The amount of ischemia and subtended myocardial mass of diagonal branches were quantified using MPI by percent ischemic myocardium (%ischemia) and CCTA by percent fractional myocardial mass (%FMM), respectively. In 49 patients with isolated diagonal branch disease, the mean %ischemia by MPI was 6.8±4.0% whereas in patients with total occlusion or severe disease of all diagonal branches, it was 8.4±3.3%. %ischemia was different according to the presence of non-diseased diagonal branches and dominant left circumflex artery (LCx). In CCTA cohort (306 patients, 564 diagonal branches), mean %FMM was 5.9±4.4% and 86 branches (15.2%) had %FMM 10%. %FMM was different according to LCx dominance, number of branches, vessel size, and relative dominance between 2 diagonal branches. The diagnostic accuracies of prediction models for %FMM 10% based on logistic regression and decision tree were 0.92 (95% CI 0.85-0.96) and 0.91 (95% CI 0.84-0.96), respectively. There was no difference in the diagnostic performance of models with and without size criterion.


CONCLUSIONS - LCx dominance, number of branches, vessel size, and dominance among diagonal branches determined the myocardial territory of diagonal branches. Clinical application of prediction models based on these anatomical attributes can help determine the clinically relevant diagonal branches in the cardiac catheterization laboratory.