Coronary Bifurcation Intervention: What Role Do Bifurcation Angles Play?

Abstract

Bifurcation angles play an important role in coronary bifurcation intervention. Bifurcation angles affect the coronary bifurcation intervention from many aspects: (1) impact the atherosclerosis proliferation via affecting the hemodynamic parameters at bifurcation regions; (2) impact side branch compromise after main vessel stenting via hemodynamics, atherosclerosis proliferation, geometric characteristics, and plaque/carina shift; (3) affect the long-term clinical outcome after coronary bifurcation stenting. Bifurcation angles are key factors to formulate the intervention strategy of stenting procedure and can also be modified by different bifurcation stenting strategies. In the last few years, significant improvements have occurred in understanding the role of bifurcation angles. However, there are still questions remain to be clarified: (1) How to measure the bifurcation angles accurately and comprehensively? (2) How do bifurcation angles impact the immediate and long term outcome of PCI? (3) Why the results of previous studies remain controversial? The exact influence of bifurcation angles on post-PCI effect like side branch compromise and clinical outcome has not been fully elucidated. In this review, we highlight the current knowledge of bifurcation angles, summarize the questions remained to be clarified, and discuss the implications for clinical practice and future studies.

Coronary computed tomography angiography investigation of the association between left main coronary artery bifurcation angle and risk factors of coronary artery disease

“…This leads to potential inter-observer and intra-observer variance. Systematic measurement of bifurcation angles should be performed at end systole and end diastole to achieve more accurate and reproducible results [33]. Despite these limitations, a recent study has shown good correlation between CCTA and invasive coronary angiography using bifurcation angle measurements as a criterion to determine coronary stenosis [34].…”

Angiographic determinants for side branch treatment in distal unprotected left main coronary artery bifurcation percutaneous coronary intervention with single stent crossover technique

“…However, the bifurcation angle could not predict the need for side branch treatment. 9,13,14 The POC represents the zone of confluence of the distal left main, ostial LAD and ostial LCX arteries. Kang et al concluded mean lumen area (MLA) within the POC may serve as a predictor of stenosis in LM disease.…”

“…However, POC was unable to predict side branch stenosis requiring the implantation of a second stent. [4][5][6][7][8][9][10][11][12][13][14][15] Studies have shown a greater SYNTAX score in patients undergoing the two-stent strategy than in the one-stent strategy in the indication of angiographic complexity in the two treatment groups. Patients in our study included patients at intermediate risk as the mean SYNTAX score was 26.7±3.7 (21-39).…”

Percutaneous Coronary Intervention: 2015 in Review

“…Stenting the parent vessel with provisional stenting of the side branch remains a superior strategy. However, others would suggest that the bifurcation angle is an important determinant of MACE and should be strongly considered before determining the appropriate revascularization strategy …”