Theoretical prediction of side branch compromise after main branch stenting in coronary bifurcation

摘要

One of the main problems of treatment of bifurcation lesions is side branch (SB) stenosis appearing after stent placement in the main vessel. The aim of this study was to create quantitative method for prediction of side branch compromise extent. We accepted that the main mechanism for SB ostial stenosis is flow divider (FD) displacement from stent struts after stent implantation in the main vessel. Using easily measurable parameters from coronary angiography, as SB diameter, angle á (initial angle between axes of parent vessel and SB axis) and angle á' (angle between above mentioned axes after stent placement) we can calculate percentage diameter stenosis at branch ostium (%DS): %DS = sin (á - á')/(tan á). In boundary condition of full FD displacement %DS = cos á. We tested our theoretical predictions with fluoroscopic observation of elastic wall model of bifurcation (45o distal angle between branches) permitting wall deformations with stent. There is full coincidence of values of %DS and percentage area stenosis (%AS). The regular formulas for calculations of %DS and %AS overestimate stenosis severity between 10% and 25%. Our model tests have shown full coincidence between predicted values for %DS and observed values. We demonstrate that part of the SB ostium is not visible in regular angiography and contributes to ostial lumen area. This is a method that permits quantitative prediction of side branch compromise.