Document Detail

Simple versus complex approaches to treating coronary bifurcation lesions: direct assessment of stent strut apposition by optical coherence tomography.
MedLine Citation:
PMID:  20738935     Owner:  NLM     Status:  MEDLINE    
INTRODUCTION AND OBJECTIVES: Stenting of coronary bifurcation lesions carries an increased risk of stent deformation and malapposition. Anatomical and pathological observations indicate that the high stent thrombosis rate in bifurcations is due to malapposition of stent struts.
METHODS: Strut apposition was assessed with optical coherence tomography (OCT) in bifurcation lesions treated either using the simple technique of stent implantation in the main vessel only or a complex technique (i.e. Culotte's). A strut was regarded as malapposed if the gap between its endoluminal surface and the vessel wall was greater than its thickness plus an OCT resolution error margin of 15 microm.
RESULTS: Simple and complex (i.e. Culotte's) approaches were used in 17 and 14 patients, respectively. Strut malapposition was significantly more frequent for the half of the bifurcation on same side as the vessel side branch (median, 46.1%; interquartile range [IQR], 35.3-62.5%) than for the half opposite the side branch (9.1%; IQR, 2.2-21.6%), the distal segment (7.5%; IQR, 2.3-20.2%) or the proximal segment (12.6%; IQR, 7.8-23.1%; P< .0001); the gap between strut and vessel wall in malapposed struts was significantly greater in the first segment than the others: 98 microm (IQR, 37-297 microm) vs. 31 microm (IQR, 13-74 microm), 49 microm (IQR, 20-100 microm) and 38 microm (IQR, 17-90 microm), respectively (P< .0001). Using the complex technique had no effect on the prevalence of strut malapposition in the four segments relative to the simple technique (P=.31) but was associated with a smaller gap in the proximal segment (47 microm vs. 60 microm; P=.0008).
CONCLUSIONS: In coronary bifurcation lesions, strut malapposition occurred most frequently and was most significant close to the side branch ostium. The use of Culotte's technique did not significantly increase the prevalence of strut malapposition compared with a simple technique.
Pawel Tyczynski; Giuseppe Ferrante; Cristina Moreno-Ambroj; Neville Kukreja; Peter Barlis; Elio Pieri; Ranil De Silva; Kevin Beatt; Carlo Di Mario
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  Revista española de cardiología     Volume:  63     ISSN:  1579-2242     ISO Abbreviation:  Rev Esp Cardiol     Publication Date:  2010 Aug 
Date Detail:
Created Date:  2010-08-26     Completed Date:  2011-01-06     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0404277     Medline TA:  Rev Esp Cardiol     Country:  Spain    
Other Details:
Languages:  eng; spa     Pagination:  904-14     Citation Subset:  IM    
Departamento de Cardiología, Royal Brompton Hospital, Londres, Reino Unido.
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MeSH Terms
Coronary Artery Disease / diagnosis*,  surgery*
Middle Aged
Prosthesis Implantation / methods
Tomography, Optical Coherence*

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