Key result
Circumferential plaque in the proximal main branch segment detected by CT coronary angiography was an independent predictor of side branch compromise after provisional stenting (OR 3.962).
Why the study?
Coronary bifurcation atherosclerosis depends on angles, flow, and extensive branching, prompting investigation into the ability of CTCA to determine plaque characteristics of true bifurcations compared with IVUS and its influence on side branch fate after PCI.
Does CTCA provide comparable information to IVUS for evaluating plaque characteristics in true coronary bifurcations and predicting side branch compromise?
Observational (n=70)
No
Does CTCA provide comparable information to IVUS for evaluating plaque characteristics in true coronary bifurcations and predicting side branch compromise?
CTCA provides comparable information to IVUS for evaluating true coronary bifurcations and can predict side branch compromise after provisional stenting.
Answers are grounded in this paper and cite their sources.
May aid side branch risk stratification in bifurcation PCI; leaves open prospective validation vs IVUS.
Aim Coronary bifurcation atherosclerosis depends on its angles, flow, and extensive branching. We investigate the ability of CT coronary angiography (CTCA) to determine atherosclerotic plaque characteristics of “true” bifurcation compared with intravascular ultrasound (IVUS) and the influence on side branch (SB) fate after percutaneous coronary intervention (PCI). Methods and results The study included 70 patients with 72 “true” bifurcations. Most of the bifurcations were in the left anterior descending—diagonal (Dg) territory [50 out of 72 (69.4%)]. Longitudinal plaque evaluation at the polygon of confluence [carina and 5 mm proximal and distal in the main branch (MB)] showed that carina side MB and SB plaque had occurred with the lowest incidence with fibro-lipid structure (115 ± 63 HU and 89 ± 73 HU, p < 0.001 for all). Bland–Altman analysis showed a discrepancy in measuring mainly the lumen area between CTCA and IVUS in proximal MB [lumen 5.10, 95% CI (95% confidence interval, 4.53–5.68) mm 2 , p < 0.001; vessel −1.42, 95% CI (−2.63 to −0.21) mm 2 , p = 0.023], carina MB [lumen 3.74, 95% CI (3.37–4.10) mm 2 , p < 0.001; vessel −0.48, 95% CI (−1.45 to 0.48) mm 2 , p = 0.322], and distal MB [lumen 4.72, 95% CI (4.27–5.18) mm 2 , p < 0.001; vessel 0.62, 95% CI (−0.53 to 1.77) mm 2 , p = 0.283]. A significant correlation existed between average plaque density on CTCA with a percentage of calcified plaque on IVUS tissue characterization (proximal r = 0.307/ p = 0.024, carina 0.469/0.008, distal 0.339/0.024, minimal lumen diameter 0.318/0.020). Circumferential plaque in the proximal MB segment remained an independent predictor of SB compromise [OR 3.962 (95% CI 1.170–13.418)]. Conclusion Detection and characterization of atherosclerotic plaque by CTCA in non-left main “true” coronary bifurcations can provide useful information about bifurcation anatomy and plaque distribution that can predict outcomes after provisional stenting, thus guiding the interventional strategy to bifurcation PCI.
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Radunović et al. (2023) conducted an observational in "true" native coronary artery bifurcations (n=70). CT coronary angiography (CTCA) vs. Intravascular ultrasound (IVUS) was evaluated on Side branch compromise (TIMI < 3) (OR 3.962, 95% CI 1.170-13.418, p=0.027). Circumferential plaque in the proximal main branch segment detected by CT coronary angiography was an independent predictor of side branch compromise after provisional stenting (OR 3.962).
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