Frequency-domain optical coherence tomography assessment of kissing-balloon effects in bifurcated coronary artery lesions undergoing provisional stenting

摘要

Stenoses located at bifurcations represent a challenging subset of coronary lesions which may benefit from invasive imaging and optical coherence tomography (OCT) has been recognized to have a promising role in this setting [1 ]. Provisional-T-stenting with drug-eluting stents (DES) represents the gold standard for percutaneous treatment of bifurcated lesions but the usefulness of final kissing balloon inflation (FKI) is not established. Indeed, in a dedicated trial, FKI has not been found to improve clinical outcome [2] even if it provides better SB ostium angiographic results [2]. To investigate the acute impact of FKI on bifurcated lesions undergoing provisional technique, we performed the present study in patients undergoing DES implantation with pre-PCI and post-PCI frequency-domain OCT assessment at our Institution. A total of 55 bifurcation lesions were analyzed in 51 lesions in 51 patients. PCI was performed according to provisional T-stenting strategy with (n = 32) or without (n = 23) FKI. OCT was performed in the MV before ("Pre-PCI OCT") and after PCI ("Post-PCI OCT"). As shown in Fig. 1, the bifurcation lesion was divided into: proximal MV, distal MV, MV opposite to SB (OSB MV), and SB ostium. Proximal and distal MV reference lumen area (RLA) and minimal lumen area (MLA) were measured at Pre-PCI OCT, while proximal and distal MV RLA, minimal stent cross-sectional area (CSA) in the proximal MV, distal MV, and OSB MV at Post-PCI OCT. SB ostium length was measured using the OCT longitudinal view reconstruction (Fig. 1).