Abstract
This repot reviews the angiographic and intravascular (IVUS) assessment of coronary bifurcation lesions. Overall, bifurcation lesion anatomy and morphology is critical for technical decision making, and a key factor for successful bifurcation PCI. Optimal viewing is essential for proper angiographic assessment, especially for evaluation of the degree of SB involvement. Current classifications based on the presence or absence of significant angiographic stenosis within the three segments of the bifurcation anatomy may not provide sufficient anatomic and morphologic information to guide technical decision making. Dedicated 2D bifurcation quantitative coronary angiography with segmental analysis of the bifurcation provides greater accuracy for quantification of the degree of stenosis in the PV and especially the SB ostium. IVUS assessment at preprocedure provides valuable information regarding vessel size, and plaque morphology and distribution (particularly in relation to the SB ostium) that may help select treatment strategy. At postprocedure, IVUS imaging evaluates stent apposition within the stented segment(s) and the appropriateness of stent expansion particularly at the SB ostium, what may impact long-term outcomes.
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References
Latib A, Colombo A (2008) Bifurcation disease: what do we know, what should we do? JACC Cardiovasc Interv 1(3):218–226
Costa RA, Moussa ID (2006) Percutaneous treatment of coronary bifurcation lesions in the era of drug-eluting stents. Minerva Cardioangiol 54(5):577–589
Steigen TK, Maeng M, Wiseth R, Erglis A, Kumsars I, Narbute I et al (2006) Randomized study on simple versus complex stenting of coronary artery bifurcation lesions: the Nordic bifurcation study. Circulation 114(18):1955–1961
Ferenc M, Gick M, Kienzle RP, Bestehorn HP, Werner KD, Comberg T et al (2008) Randomized trial on routine vs. provisional T-stenting in the treatment of de novo coronary bifurcation lesions. Eur Heart J 29(23):2859–2867
Hildick-Smith D, de Belder AJ, Cooter N, Curzen NP, Clayton TC, Oldroyd KG et al (2010) Randomized trial of simple versus complex drug-eluting stenting for bifurcation lesions. The British bifurcation coronary study: old, new, and evolving strategies. Circulation 121:1235–1243
Routledge HC, Morice MC, Lefevre T, Garot P, De Marco F, Vaquerizo B et al (2008) 2-year outcome of patients treated for bifurcation coronary disease with provisional side branch T-stenting using drug-eluting stents. JACC Cardiovasc Interv 1(4):358–365
Colombo A, Bramucci E, Sacca S, Violini R, Lettieri C, Zanini R et al (2009) Randomized study of the crush technique versus provisional side-branch stenting in true coronary bifurcations: the CACTUS (coronary bifurcations: application of the crushing technique using sirolimus-eluting stents) Study. Circulation 119(1):71–78
Latib A, Cosgrave J, Godino C, Qasim A, Corbett SJ, Tavano D et al (2008) Sirolimus-eluting and paclitaxel-eluting stents for the treatment of coronary bifurcations. Am Heart J 156(4):745–750
Moussa I, Colombo A (2010) Coronary artery bifurcation interventions: bridging the gap between research and practice. In: Moussa I, Colombo A (eds) Tips and tricks in interventional therapy of coronary bifurcation lesions. Informa Healthcare, London
Costa RA, Kyono H, Costa M, Russell M, Moussa ID (2010) Coronary artery bifurcation lesions: anatomy. In: Moussa ID, Colombo A (eds) Tips and tricks in interventional therapy of coronary bifurcation lesions, 1st edn. Informa Healthcare, London
Medina A, Suarez de Lezo J, Pan M (2006) A new classification of coronary bifurcation lesions. Rev Esp Cardiol 59(2):183
Costa RA, Furuichi S, Lansky AJ, Mintz GS, Montorfano M, Carlino M et al (2008) Midterm clinical outcomes from the intravascular ultrasound investigation of the parent vessel and the side branch in coronary bifurcation lesions treated with different stenting techniques. J Am Coll Cardiol 51:B51
Latib A, Moussa I, Sheiban I, Colombo A (2011) When are two stents needed? Which technique is the best? How to perform? EuroIntervention 6(Suppl J):J81–J87
Hildick-Smith D, Lassen JF, Albiero R, Lefevre T, Darremont O, Pan M et al (2010) Consensus from the 5th European bifurcation club meeting. EuroIntervention 6(1):34–38
Pan M, de Lezo JS, Medina A, Romero M, Segura J, Pavlovic D et al (2004) Rapamycin-eluting stents for the treatment of bifurcated coronary lesions: a randomized comparison of a simple versus complex strategy. Am Heart J 148(5):857–864
Pan M, Suarez de Lezo J, Medina A, Romero M, Delgado A, Delgado A, Segura J et al (2007) Drug-eluting stents for the treatment of bifurcation lesions: a randomized comparison between paclitaxel and sirolimus stents. Am Heart J 153(1):15e1–15e7
Hoye A, Iakovou I, Ge L, van Mieghem CA, Ong AT, Cosgrave J et al (2006) Long-term outcomes after stenting of bifurcation lesions with the “crush” technique: predictors of an adverse outcome. J Am Coll Cardiol 47(10):1949–1958
Thuesen L, Kelbaek H, Klovgaard L, Helqvist S, Jorgensen E, Aljabbari S et al (2006) Comparison of sirolimus-eluting and bare metal stents in coronary bifurcation lesions: subgroup analysis of the Stenting Coronary Arteries in Non-Stress/Benestent Disease Trial (SCANDSTENT). Am Heart J 152(6):1140–1145
Colombo A, Moses JW, Morice MC, Ludwig J, Holmes DR Jr, Spanos V et al (2004) Randomized study to evaluate sirolimus-eluting stents implanted at coronary bifurcation lesions. Circulation 109(10):1244–1249
Tanabe K, Hoye A, Lemos PA, Aoki J, Arampatzis CA, Saia F et al (2004) Restenosis rates following bifurcation stenting with sirolimus-eluting stents for de novo narrowings. Am J Cardiol 94(1):115–118
Chaudhry EC, Dauerman KP, Sarnoski CL, Thomas CS, Dauerman HL (2007) Percutaneous coronary intervention for major bifurcation lesions using the simple approach: risk of myocardial infarction. J Thromb Thrombolysis 24(1):7–13
Arora RR, Raymond RE, Dimas AP, Bhadwar K, Simpfendorfer C (1989) Side branch occlusion during coronary angioplasty: incidence, angiographic characteristics, and outcome. Cathet Cardiovasc Diagn 18(4):210–212
Sianos G, Morel MA, Kappetein AP, Morice MC, Colombo A, Dawkins K et al (2005) The SYNTAX score: an angiographic tool grading the complexity of coronary artery disease. EuroIntervention 1(2):219–227
Koo BK, Park KW, Kang HJ, Cho YS, Chung WY, Youn TJ et al (2008) Physiological evaluation of the provisional side-branch intervention strategy for bifurcation lesions using fractional flow reserve. Eur Heart J 29(6):726–732
Furukawa E, Hibi K, Kosuge M, Nakatogawa T, Toda N, Takamura T et al (2005) Intravascular ultrasound predictors of side branch occlusion in bifurcation lesions after percutaneous coronary intervention. Circ J 69(3):325–330
Lansky A, Tuinenburg J, Costa M, Maeng M, Koning G, Popma J et al (2009) Quantitative angiographic methods for bifurcation lesions: a consensus statement from the European Bifurcation Group. Catheter Cardiovasc Interv 73(2):258–266
Ellis SG, Vandormael MG, Cowley MJ, DiSciascio G, Deligonul U, Topol EJ et al (1990) Coronary morphologic and clinical determinants of procedural outcome with angioplasty for multivessel coronary disease. Implications for patient selection. Multivessel angioplasty prognosis study group. Circulation 82(4):1193–1202
Burzotta F, De Vita M, Sgueglia G, Todaro D, Trani C (2011) How to solve difficult side branch access? EuroIntervention 6(Supplement J):J72–J80
Lefevre T, Louvard Y, Morice MC, Dumas P, Loubeyre C, Benslimane A et al (2000) Stenting of bifurcation lesions: classification, treatments, and results. Catheter Cardiovasc Interv 49(3):274–283
van der Waal EC, Mintz GS, Garcia-Garcia HM, Bui AB, Pehlivanova M, Girasis C et al (2009) Intravascular ultrasound and 3D angle measurements of coronary bifurcations. Catheter Cardiovasc Interv 73(7):910–916
Medina A, Martin P, Suarez de Lezo J, Novoa J, Melian F, Hernandez E et al (2011) Ultrasound study of the prevalence of plaque at the carina in lesions that affect the coronary bifurcation. Implications for treatment with provisional stent. Rev Esp Cardiol 64(1):43–50
Costa RA, Mintz GS, Carlier SG, Lansky AJ, Moussa I, Fujii K et al (2005) Bifurcation coronary lesions treated with the “crush” technique: an intravascular ultrasound analysis. J Am Coll Cardiol 46(4):599–605
Costa RA, Mintz GS, Carlier SG, Fujii K, Takebayashi H, Takenori Y et al (2005) Impact of final lumen dimensions on restenosis after crush drug-eluting stent implantation for bifurcation lesions. J Am Coll Cardiol 45:3A
Hahn JY, Song YB, Lee SY, Choi JH, Choi SH, Kim DK et al (2009) Serial intravascular ultrasound analysis of the main and side branches in bifurcation lesions treated with the T-stenting technique. J Am Coll Cardiol 54(2):110–117
Sonoda S, Morino Y, Ako J, Terashima M, Hassan AH, Bonneau HN et al (2004) Impact of final stent dimensions on long-term results following sirolimus-eluting stent implantation: serial intravascular ultrasound analysis from the sirius trial. J Am Coll Cardiol 43(11):1959–1963
Sano K, Mintz GS, Carlier SG, Solinas E, Costa JR Jr, Qian J, Missel E, Shan S, Franklin-Bond T, Boland P, Weisz G, Moussa I, Dangas G, Mehran R, Lansky AJ, Kreps E, Collins M, Stone GW, Moses JW, Leon MB (2007) Treatment of restenotic drug-eluting stents: an intravascular ultrasound analysis. J Invasive Cardiol 19(11):464–468
Colombo A, Stankovic G, Orlic D, Corvaja N, Liistro F, Airoldi F et al (2003) Modified T-stenting technique with crushing for bifurcation lesions: immediate results and 30-day outcome. Catheter Cardiovasc Interv 60(2):145–151
Mintz GS, Weissman NJ (2006) Intravascular ultrasound in the drug-eluting stent era. J Am Coll Cardiol 48(3):421–429
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Costa, R.A., Costa, M.A. & Moussa, I.D. Bifurcation lesion morphology and intravascular ultrasound assessment. Int J Cardiovasc Imaging 27, 189–196 (2011). https://doi.org/10.1007/s10554-011-9846-x
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DOI: https://doi.org/10.1007/s10554-011-9846-x