Bifurcation lesions: Functional assessment by fractional flow reserve vs. anatomical assessment using conventional and dedicated bifurcation quantitative coronary angiogram

Abstract

In bifurcation lesions the correlation between the anatomic severity of a coronary stenosis and its functional significance appears to be somewhat higher when QCA is performed using the three branch model. This is most notable for side-branch stenoses which can be overestimated when using conventional QCA.

Functional Assessment of Jailed Side Branches in Coronary Bifurcation Lesions Using Fractional Flow Reserve

“…Therefore, DS of the current study tends to be lower than that of previous studies (9,10,12,21). In addition, a recent study demonstrated that dedicated bifurcation QCA was better correlated with the functional significance of the side branch (6). Nevertheless, no angiographic parameter was able to adequately predict the functional significance of side branches.…”

“…Although angiographic stenosis of a side branch ostium is frequently observed after stent implantation in a main vessel, the clinical advantages of treating these lesions using complex interventional strategies remain unclear (1)(2)(3), and such interventions may increase the subsequent risk of adverse clinical events (4,5). In addition, these lesions cannot be properly evaluated by conventional coronary angiograms (6,7).…”

“…These findings have profound implications in guiding strategies of bifurcation coronary artery stenosis management. However, these studies examined a limited number of lesions and did not use dedicated bifurcation quantitative coronary angiography (QCA) analysis (6). To determine the incidence and predictors of functionally significant side branch stenosis and to compare the FFR value with QCA parameters, we measured FFR of side branches after stent implantation in main vessels in a large number of coronary bifurcation lesions.…”

Angiographic and Clinical Outcomes after Implantation of Drug Eluting Stents in Bifurcation Lesions with Crush or Kissing Stent Technique

“…Furthermore, the TVR was seen in 8% of all patients suggesting asymptomatic status for most side branch restenosis. This is consistent with other studies showing poor correlation between angiographic assessment by QCA and hemodynamic significance for side branch stenosis after bifurcation stenting …”

Comparison between two‐ and three‐dimensional quantitative coronary angiography bifurcation analyses for the assessment of bifurcation lesions: A subanalysis of the TRYTON pivotal IDE coronary bifurcation trial

“…Indeed the kappa values suggested insufficient agreement between the two analysis approaches (kappa: 0.50 for the smallest MLD sites and 0.55 for the highest DS sites). From the clinical perspective, it has been reported that the DS measured by dedicated 2D bifurcation QCA algorithm showed a better correlation with invasive fractional flow reserve (FFR) than that by a conventional single‐vessel 2D QCA technique, and this advantage was more pronounced in SB . It is also noteworthy that Yong et al demonstrated that 3D QCA derived measurements showed better predictive ability in detecting functionally significant stenosis determined by invasive FFR as compared to 2D QCA derived measurements in simple lesions .…”