Importance of Proximal Angle in Generation of Abnormal Plaque at Coronary Bifurcation Lesions

Abstract

BACKGROUND: Changing of linear blood flow to turbulence at branching points predisposes to development of obstructive coronary lesions. We hypothesize that in addition to bifurcation angle (BA), proximal (PA) and third angle (TA) of branching site are important in generating more vertices of blood flow.METHODS: 65 normal and 36 significantly diseased LAD – D1, 72 normal and 27 significantly diseased LCX – OM, 73 normal and 16 significantly diseased RCA – PDA – PLV and 34 normal and 14 significantly diseased LMCA – LAD – LCX bifurcations were analyzed with QCA.RESULTS: In LAD – D1 normal vs. significantly diseased bifurcations BA and PA were 78.2±13.2 vs. 65.1±11.3 (p <0.000) and 122.7±13.8 vs. 131.6.36±12.5 (p <0.001) respectively. In LCX – OM normal vs. significantly diseased bifurcations BA and PA were 76.8±13.6 vs. 60.7±13.8 (p=0.000) and 125.1±13.5 vs. 137.8±12.8 (p <0.000) respectively. In RCA - PDA – PLV normal vs. significantly diseased bifurcations BA, PA and TA were 91.1±13.8 vs. 71.5±15.9 (p 0.004), 113.0±14.1 vs. 128.4±20.2 (p=0.000), 118.2±21.7 vs. 133.8±12.4 (p=0.007) respectively. In LMCA –LAD – LCX normal vs. significantly diseased bifurcations BA, PA and TA were 84.0±39.1 vs. 73.0±17.6 (p >0. 32), 123.2±26.3 vs. 115.3±30.4 (p > 0.38), 130.3±27.3 vs. 137.5±33.5 (p >0.45) respectively. There was a significant difference but no correlation between the angles in normal and diseased bifurcation segment. We derived logistic regression equations for predicting the disease in different coronary bifurcations.CONCLUSION: In LAD - D1, LCX – OM and RCA – PDA – PLV bifurcations lesser the BA, greater the PA, were more likely to develop significant lesion, which was not true in LMCA – LAD – LCX bifurcation.

Coronary Bifurcation Lesion–Management

“…So, proximal angle is not just 180°minus the bifurcation angle. 24 The predictors of SB occlusion 25 Whereas jailed wire technique, SB predilatation, and IVUS guidance were not predictors for SB occlusion.…”