Hemodynamic impact of changes in bifurcation geometry after single‐stent cross‐over technique assessed by intravascular ultrasound and fractional flow reserve. Issue 7 (1st August 2013)

• Record Type: Journal Article
• Authors: Kang, Soo‐Jin; Kim, Won‐Jang; Lee, Jong‐Young; Park, Duk‐Woo; Lee, Seung‐Whan; Kim, Young‐Hak; Lee, Cheol Whan; Mintz, Gary S.; Park, Seong‐Wook; Park, Seung‐Jung
• Is Part Of: Catheterization and cardiovascular interventions. Volume 82:Issue 7(2013:Dec. 01)
• Page Start: 1075
• Page End: 1082
• Publication Date: 2013-08-01
• Subjects: Heart -- Diseases -- Diagnosis -- Periodicals; Cardiac catheterization -- Periodicals; 616.1207572
• DOI: 10.1002/ccd.24956
• Languages: English
• ISSNs: 1522-1946

Abstract

<abstract abstract-type="main"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="ccd24956-sec-0001" sec-type="section"> <title>Background</title> <p>Angiographic stenosis of a sidebranch (SB) ostium is common after single‐stent cross‐over, but it is usually not hemodynamically significant. We evaluated the relationship between the mechanisms of SB stenosis and its hemodynamic significance.</p> </sec> <sec id="ccd24956-sec-0002" sec-type="section"> <title>Methods and Results</title> <p>We used preinterventional and post‐interventional intravascular ultrasound (IVUS) of the main branch (MB) and the SB and post‐intervention fractional flow reserve (FFR) of the SB to assess 40 nonleft main bifurcation lesions after a single stent cross‐over. Although post‐stenting angiographic diameter stenosis >50% was seen in 19 (48%) SB lesions, only 6 (15%) showed FFR < 0.80. Carina shift was seen in all but one lesion; and plaque shift superimposed on the carina shift was found in 18 (45%) lesions. The change in plaque area at the SB ostium positively correlated with preprocedural plaque burden at the carina of distal MB <italic>r</italic> = 0.341, <italic>P</italic> = 0.031). Plaque shift was more common in lesions with FFR < 0.80 vs. ≥0.80 (83% vs. 38%, <italic>P</italic> = 0.041); and FFR < 0.80 was more frequent in lesions with plaque shift superimposed on carina shift versus isolated carina shift (28% vs. 5%, <italic>P</italic> = 0.041).</p> </sec> <sec id="ccd24956-sec-0003" sec-type="section"> <title>Conclusions</title> <p>Although carina shift was the main mechanism of SB lumen loss after a single stent cross‐over technique, plaque shift superimposed on carina shift appeared to be necessary to cause a hemodynamically significant stenosis (FFR < 0.80). However, post‐procedural IVUS assessment did not accurately predict the functional significance. © 2013 Wiley Periodicals, Inc.</p> </sec> </abstract>