The treatment of bifurcation lesions is complex and increasingly common. A growing number of dedicated bifurcation devices are under clinical evaluation, but no standardized methodology exists. Specifically, the angiographic analysis of bifurcation lesions is not standardized and current QCA packages are not designed for bifurcation lesions. This consensus statement outlines the limitations of conventional QCA in the bifurcation application, and outlines a new standard approach for the analysis and reporting of the angiographic results of the bifurcation lesion allowing for future trial and device comparisons and mechanistic insight into location and modes of treatment failure.

Ouantitative coronary arteriography I edited by Johan H.C. Reiber and Patrlck W. Serruys. p. cm. --(Developments in cardiovascular medicine ; v. 117) lnc 1 udes index.

In selected patients with previous stent implantation, 64-section CT can be used to evaluate in-stent restenosis with high accuracy. Accordingly, the technique may be useful for noninvasive exclusion of in-stent or peristent restenosis, thereby avoiding invasive imaging in a considerable number of patients.

This paper presents new approaches for the assessment of the arterial and reference diameters in (cardio-)vascular X-ray images, designed to overcome the problems experienced in conventional quantitative coronary and vascular angiography approaches. In single or “straight” vessel segments, the arterial and reference diameter directions were made independent of each other in order to be able to measure the minimal lumen diameter (MLD) more accurately, especially in curved vessel segments. For ostial segments, an extension of this approach was used, to allow measurement of ostial lesions in sidebranches more proximal than using conventional methods. Furthermore, two new bifurcation approaches were developed. The validation study shows that the straight segment approach results in significant smaller MLDs (on average 0.032 mm) and the ostial approach achieves on average an increase in %DS of 3.8% and an increase in lesion length of 0.59 mm due to loosening the directional constraint. The validation of our new bifurcation approaches in phantom data as well as clinical data shows only small differences between pre- and post-intervention measurements of the reference diameters outside the bifurcation core (errors smaller than 0.06 mm) and the bifurcation core area (errors smaller than 1.4% for phantom data). In summary, these new approaches have led to further improvements in the quantitative analyses of (cardio-)vascular X-ray angiographies.