Changes in Left Main Bifurcation Geometry After a Single-Stent Crossover Technique
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Implication
Imaging study demonstrates acute lumen loss at the left circumflex ostium after crossover stenting, indicating that carina shift in narrow bifurcation angles drives ostial narrowing.
Key Points
- To assess the geometric mechanisms responsible for acute lumen loss at the left circumflex coronary artery ostium following crossover stenting from the left main to the left anterior descending artery.
- Evaluated 23 left main bifurcation lesions with baseline left circumflex artery (LCX) ostial angiographic diameter stenosis <50%.
- Conducted pre- and post-stenting intravascular ultrasound pullbacks in both the left anterior descending (LAD) and LCX vessels to quantify minimal lumen area, plaque+media area, and external elastic membrane dimensions.
- Minimal lumen area at the LCX ostium significantly decreased from 5.4 mm² (quartiles: 4.3, 7.2 mm²) prestenting to 4.0 mm² (quartiles: 3.0, 4.8 mm²) poststenting (P < 0.001).
- A smaller baseline carina angle between the LAD and LCX correlated with a greater percent reduction in lumen area (r = 0.472, P = 0.023) and external elastic membrane area (r = 0.402, P = 0.048).
- In 18 lesions with >10% lumen loss, change in plaque area strongly correlated with the ratio of external elastic membrane change to lumen change (r = -0.953, P < 0.001).
Cite This Study
Kang et al. (2011) studied this question.