Optical Coherence Tomography Predictors of SIde Branch REstenosis after unprotected Left Main bifurcation angioplasty using double kissing crush technique (OP‐SIBRE LM Study)

Abstract

BackgroundAmong the two stent strategies, contemporary evidence favors double kissing crush technique (DKC) for complex unprotected distal left main bifurcation (UdLMB) lesions. However one of the major challenges to these lesions is side branch (SB) restenosis.AimsOur aim was to identify optical coherence tomographic (OCT) characteristics that may predict SB restenosis (SBR) after UdLMB angioplasty using DKC technique.MethodsThis was a single‐center, retrospective study that included 60 patients with complex UdLMB disease, who underwent OCT‐guided angioplasty using DKC technique. Angiographic follow‐up was performed in all patients at 1 year to identify patients with SBR. Patients with SBR group were compared with patients without SBR (NSBR group) for OCT parameters during index procedure.ResultsTwelve (20%) patients developed SBR at 1‐year follow‐up. The SBR group had longer SB lesion (18.8 ± 3.2 vs. 15.3 ± 3.7 mm, p = 0.004) and neo‐metallic carinal length (2.1 vs. 0.1 mm, p < 0.001) when compared to the NSBR group. Longer neo‐metallic carinal length was associated with the absence of the dumbbell sign, presence of hanging stent struts across the SB ostium on OCT of final MB pullback. On multivariate regression analysis, SB distal reference diameter (DRD) and SB stent expansion were identified as independent predictors of SBR with SB‐DRD of ≤2.8 mm (area under curve—0.73, sensitivity—83.3%, and specificity—62.5%) and SB stent expansion of ≤89% (area under curve—0.88, sensitivity—83.3%, and specificity‐ 81.2%) as the best cut off values to predict SBR.ConclusionsSB DRD and SB stent expansion are the OCT predictors of future SBR after UdLMB angioplasty using DKC technique.

The Randomized, Multicenter, Open-Label, Controlled POLBOS 3 Trial Comparing Regular Drug-Eluting Stents and the Sirolimus-Eluting BiOSS LIM C Dedicated Coronary Bifurcation Stent: Four-Year Results

“…Secondly, among complex lesion subsets, the DK crush technique emerges as superior to alternative approaches [6,37]. Lastly, while a dedicated two-stent strategy appears more effective than a provisional strategy in treating complex bifurcations, the superiority of a two-stent strategy in "noncomplex" bifurcations remains uncertain [38,39]. Also, smaller bifurcations (non-LM bifurcations), as our study shows, can be safely treated with a provisional stenting technique.…”

Nailing the left anterior artery ostium in true 0,1,0 left main bifurcation disease and understanding its complication using optical coherence tomography

“… 3 , 4 Moreover, OCT has recently been used to identify the predictors of side branch restenosis after LM bifurcation angioplasty with double kissing crush technique, and based on the findings, some modifications of the double kissing crush technique have been suggested. 5 Its high resolution and availability of various modes like L mode, B mode, and 3D reconstruction make it a better option than IVUS in bifurcation angioplasty. 6 This case is the classic example of how high-resolution OCT helped in the understanding of complication.…”