Association between plaque characteristics and side-branch compromise in left main bifurcation lesions after a single-stent crossover technique: insights from an optical coherence tomography study

Background The primary mechanism underlying side branch (SB) ostial compromise following main vessel (MV) stenting is the MV carina shift. However, the association between plaque characteristics or distribution and SB compromise remains unclear in patients with left main (LM) bifurcation lesions. Methods A total of 123 patients with LM bifurcation lesions were included in the final analysis. Preprocedural optical coherence tomography (OCT) assessment of the LM-to-left anterior descending artery (LAD) segment was performed, and patients were treated with a single-stent crossover technique. Quantitative coronary angiography was performed to evaluate LM, LAD, and proximal left circumflex artery (LCX). Left circumflex artery ostium (LCX-OS) compromise was defined as residual stenosis 50% after MV stenting. Results LCX-OS compromise was observed in 33 patients in this study. Compared to the no compromise LCX-OS group, the compromise group had a higher frequency of plaque distribution in the LAD (90.9% vs. 65.6%, p 0.001), more prominent calcified plaque characteristics (60.6% vs. 24.4%, p 0.001), and a smaller LAD-LCX angle (81.2 ± 20.1 vs. 98.0 ± 25.7, p = 0.001). Adjusted multivariate logistic regression analysis revealed that plaques distributed in the proximal LAD (OR, 6.119; p = 0.011), calcified plaque (OR, 6.511; p = 0.001), and the LAD-LCX angle (OR, 0.966; p = 0.003) were independent predictors of LCX-OS compromise. Conclusions Plaque in the proximal LAD, presence of calcified plaque, and a smaller LAD-LCX angle may contribute to LCX-OS compromise following MV stenting in patients with LM bifurcation lesions. OCT has emerged as a promising tool for preprocedural risk stratification in LM bifurcation percutaneous coronary intervention, helping to mitigate the risk of LCX-OS compromise.