Background: Angiographic stenosis of a jailed side-branch ostium is usually observed after a single-stent crossover at coronary bifurcation lesions. However, the stenosis severity is typically overestimated due to the limited information obtained from two-dimensional morphology by angiography. We evaluated the actual stenosis of jailed side-branch ostium using three-dimensional (3D) optical coherence tomography (OCT). Methods: Using 3D reconstructions of OCT data, we analyzed minimal lumen area (MLA) and eccentricity of the jailed side-branch ostium in 41 patients who were treated with single stent crossover at coronary bifurcation lesions and subsequently underwent serial OCT follow-up. Results: The MLA of jailed side-branch ostium calculated from quantitative coronary angiography (QCA) assuming a circular lumen markedly decreased after stent implantation (1.73±1.22mm2 pre-intervention to 0.84±0.91mm2 post-intervention, p<0.001). However, the MLA of jailed side-branch ostium measured at post-intervention by 3D-OCT (2.67±1.75mm2) was significantly larger than that measured by QCA (p<0.001). There were no statistically significant changes in MLA of jailed side-branch ostium based on 3D-OCT measurements during the follow-up (2.35±1.50mm2 at 3-6 months post-intervention; 2.44±1.27mm2 at 1-2 years post-intervention, p=0.098). The shapes of the jailed side-branch ostium were nearly elliptical (mean eccentricity index: 2.97±1.27 post-intervention; 2.79±1.17 at 3-6 months post-intervention; 2.59±1.02 at 1-2 years post-intervention). Conclusions: Compared to 3D-OCT measurements, QCA measurements overestimated the jailed side-branch ostial stenosis after single stent crossover due to eccentric morphology from orthogonal projection in coronary angiography. Significant changes in the MLA of jailed side-branch ostium by 3D-OCT were not observed during the follow-up.
Bibliographical noteFunding Information:
This study was supported by a grant from the Korea Healthcare Technology R&D Project, Ministry of Health, Welfare & Family Affairs , Republic of Korea (No. A085012 and A102064 ), a grant from the Korea Health 21 R&D Project, Ministry of Health and Welfare , Republic of Korea (No. A085136 ), and from the Cardiovascular Research Center, Seoul, Korea.
All Science Journal Classification (ASJC) codes
- Cardiology and Cardiovascular Medicine