Dynamic assessment of the left main-left circumflex bending angle: Implications for ostial left circumflex artery in-stent restenosis after successful two-stent PCI. (1st May 2023)

• Record Type: Journal Article
• Authors: Wang, Zhiqing; Yang, Junqing; Li, Chunming; Huang, Jiayue; Fezzi, Simone; Chen, En; Cai, Wei; Stankovic, Goran; Wijns, William; Chen, Lianglong; Tu, Shengxian
• Is Part Of: International journal of cardiology. Volume 378(2023)
• Page Start: 11
• Page End: 19
• Publication Date: 2023-05-01
• Subjects: Left main bifurcation lesion -- Left main-left circumflex bending angle -- Distal bifurcation angle -- Cardiac motion-induced angle change -- In-stent restenosis; 3D 3-dimensional -- ∆CAngle cardiac motion-induced angulation change -- ∆SAngle stent-induced angulation change -- BALM-LCx left main-left circumflex bending angle -- DBA distal bifurcation angle -- DS% percent diameter stenosis -- ICC intraclass correlation coefficient -- ISR in-stent restenosis -- IVUS intravascular ultrasound -- LAD left anterior descending coronary artery -- LCx left circumflex coronary artery -- LM left main -- LMB left main bifurcation -- PCI percutaneous coronary intervention -- QCA quantitative coronary angiography; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2023.02.030
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Background: Two-stent techniques for percutaneous coronary intervention (PCI) on left main (LM) bifurcation (LMB) lesions are associated with an increased risk of in-stent restenosis (ISR) at left circumflex artery (LCx) ostium but the underlying mechanisms are incompletely understood. This study sought to investigate the association between cyclic change of LM-LCx bending angle (BALM-LCx ) and the risk of ostial LCx ISR following two-stent techniques. Methods: In a retrospective cohort of patients undergoing two-stent PCI for LMB lesions, BALM-LCx and distal bifurcation angle (DBA) were computed with 3-dimensional angiographic reconstruction. The analysis was performed both at end-diastole and end-systole, and the angulation change throughout the cardiac cycle was defined as the cardiac motion-induced angulation change (∆C Angle). Results: A total of 101 patients were included. The mean pre-procedural BALM-LCx was 66.8 ± 16.1° at end-diastole and 54.1 ± 13.3° at end-systole with a range of 13.0 ± 7.7°. Pre-procedural ∆C BALM-LCx > 16.4° was the most relevant predictor of ostial LCx ISR (adjusted OR 11.58, 95% CI 4.04–33.19; p < 0.001). Post-procedural ∆C BALM-LCx > 9.8° and stent-induced diastolic BALM-LCx change > 11.6° were also related with ostial LCx ISR. DBA was positively correlated with BALM-LCx and showed a weaker association of pre-procedural ∆C DBA > 14.5° with ostial LCx ISR (adjusted OR 6.87, 95% CI 2.57–18.37; p < 0.001). Conclusions: Three-dimensional angiographic bending angle is a feasible and reproducible novel method for LMB angulation measurement. A large pre-procedural cyclic change of BALM-LCx was associated with an increased risk of ostial LCx ISR following two-stent techniques. Highlights: The3-dimensional angiography-based bending angle analysis is feasible and highlyreproducible. A large pre-procedural cyclic change of BALM-LCx was associated with ostial LCx ISR following two-stent PCI. Post-procedural cyclic change of BALM-LCx and stent-induced diastolic BALM-LCx change were also related toostial LCx ISR.