Side branch complication after a single-stent crossover technique: prediction with frequency domain optical coherence tomography.

Objectives: To identify preprocedural predictors of side branch (SB) complications after coronary bifurcation stent implantation using frequency domain optical coherence tomography (FD-OCT).

Background: Coronary bifurcation lesions are common but difficult to treat. Longitudinal reconstruction images of FD-OCT have high image quality and less motion artifacts.

Methods: Among 49 patients (age: 69.9 years) who underwent elective coronary stenting, 52 bifurcation lesions without baseline SB stenosis were studied. SB complication was defined as angiographic worsening of SB stenosis (>75%). On the basis of preprocedural FD-OCT imaging, plaque distribution, SB angle, carina tip angle (CT angle), and length between proximal branching point to carina tip (BP-CT length) were evaluated.

Results: SB complication was observed in 22 lesions. The eccentric plaque distribution oriented toward the opposite side of SB at the CT was significantly more frequent in lesions with SB complication compared with those without (77.3 vs. 16.7%, P<0.01). CT angle and BP-CT length were significantly smaller in lesions with SB complication compared with those without [29.5° (interquartile range (IQR) 22.3-44.3°) vs. 65.0° (IQR 42.5-90.0°)], P<0.001; 1.20 mm (IQR 0.70-1.73 mm) vs. 2.25 mm (IQR 1.78-3.20 mm), P<0.001, respectively]. The receiver-operating characteristic curve indicated a CT angle less than 50° (area under the curve=0.81, sensitivity 86%, specificity 70%) and BP-CT length less than 1.70 mm (area under the curve=0.84, sensitivity 77%, specificity 77%) as the best cutoff values for predicting the SB complication after main vessel stent implantation.

Conclusion: This FD-OCT study showed that narrower CT angle and shorter BP-CT length were the independent predictors for SB complications after bifurcation stenting.