Intravascular ultrasound predictors of acute side branch occlusion in coronary artery bifurcation lesions just after single stent crossover.

OBJECTIVES: We aimed to assess the intravascular ultrasound (IVUS) predictors of acute side branch (SB) occlusions just after single stent crossover in percutaneous coronary intervention (PCI) for coronary bifurcation lesions.

BACKGROUND: PCI for bifurcation lesions remains technically challenging and has more clinical complications such as SB occlusion than non-bifurcation lesions. Although single stent crossover is the most common approach in treating bifurcation lesions, the predictors of acute SB occlusion are unclear.

METHODS: Single stent crossover was performed on 174 patients with a total of 272 bifurcation lesions who were enrolled in this study. Each patient also underwent pre-PCI IVUS in a major vessel (MV). SB was defined as ostium diameter of ≥1.5 mm measured by IVUS, and occluded SB was defined as a thrombolysis in myocardial infarction flow grade of ≤2 just after stent implantation. We defined the SB diameter ratio as ostial SB total diameter (media-to-media) divided by ostial SB luminal diameter (intima-to-intima).

RESULTS: There were 52 SBs in the occluded group (19.1%). There were no significant differences in baseline characteristics between the SB occluded and non-SB occluded groups. Logistic-regression analysis revealed that the thickness of MV plaque on the bilateral sides of SB at the junction site and the SB diameter ratio were independent predictors of SB occlusion just after stent implantation.

CONCLUSIONS: In the IVUS observation, the MV plaque thickness at the junction site and the SB diameter ratio are predictors of acute SB occlusion just after single stent crossover.