Extension distance mismatch--an unrecognized factor for suboptimal side branch ostial coverage in bifurcation lesion stenting

Journal of Interventional Cardiology
Dobrin VassilevAlexander Doganov

Abstract

The unsatisfactory side branch (SB) ostial strut coverage remains a problem in coronary bifurcation stenting. Both the surplus and lack of struts at SB ostium may be the causative mechanism. We propose that the inability of available stents to cover the "extension distance" of the bifurcation region is the cause of in-stent restenosis. The extension distance (ED) is defined as the maximal distance at the carina tip, which must be covered by the stent struts to ensure optimal coverage of the main branch (MB) and SB openings. A mathematical model was created, representing the key factors that govern geometrical reconfigurations after stent implantation in bifurcations. There are two options--with and without bifurcation region deformation. The theoretical assumptions were tested on a bifurcation model (soft polyvinylchloride polymer tubes) permitting free wall deformations and the following parameters: Parent Vessel, MB, SB diameters of 3.5, 3.0, and 2.5 mm, respectively, with an angle of 45 degrees between the MB and SB. After stenting, final KBI with 3.5 mm and 3.0 mm balloons was performed up to 20 atm. After the carina displacement, the ED, which has to be covered, is considerably smaller if the suboptimal result (DS >50%) at...Continue Reading

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References

Jan 1, 1983·Journal of Biomechanics·M Zamir, N Brown
Jun 11, 2002·Journal of Interventional Cardiology·T LefèvreP Dumas
May 18, 2004·Heart·Yves LouvardMarie-Claude Morice
Aug 16, 2005·Journal of the American College of Cardiology·Ricardo A CostaJeffrey W Moses
Oct 18, 2005·Journal of the American College of Cardiology·Ioannis IakovouAntonio Colombo
Dec 30, 2008·EuroIntervention : Journal of EuroPCR in Collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology·Alfredo R GalassiCorrado Tamburino

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Citations

Feb 16, 2012·EuroIntervention : Journal of EuroPCR in Collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology·Vasim FarooqPatrick W Serruys
May 17, 2014·EuroIntervention : Journal of EuroPCR in Collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology·Francesco BurzottaCarlo Trani
Aug 20, 2010·Journal of Interventional Cardiology·Thach NguyenRun-Lin Gao

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