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  • Title: Serial intravascular ultrasound analysis of the main and side branches in bifurcation lesions treated with the T-stenting technique.
    Author: Hahn JY, Song YB, Lee SY, Choi JH, Choi SH, Kim DK, Lee SH, Gwon HC.
    Journal: J Am Coll Cardiol; 2009 Jul 07; 54(2):110-7. PubMed ID: 19573726.
    Abstract:
    OBJECTIVES: This study sought to investigate the mechanism of restenosis and the predictive value of post-procedural minimum stent area (MSA) in the side branch (SB) after coronary bifurcation stenting. BACKGROUND: The mechanism of restenosis, especially at the SB ostium, has not been fully elucidated. METHODS: This study examined 73 bifurcation lesions with post-procedural and 9-month follow-up intravascular ultrasound images for both main vessel (MV) and SB. All lesions were treated with drug-eluting stents using the T-stenting technique. Analysis included 5 distinct locations: MV proximal stent, MV middle area, MV distal stent, SB ostium (<5 mm distal to the neocarina), and SB distal stent. RESULTS: Stent expansion was significantly less in the SB than in the MV (87.1 +/- 20.4% vs. 97.0 +/- 29.1%, p = 0.007). The SB ostium was the most frequent site of post-procedural MSA. At the SB ostium, follow-up minimum lumen area (MLA) correlated with post-procedural MSA (r = 0.81, p < 0.001). The percentage of neointimal area was higher at the SB ostium than at the MV proximal, MV distal, and SB distal stent (23.8 +/- 18.9% vs. 13.3 +/- 17.3%, 15.4 +/- 20.5%, and 12.5 +/- 17.2%, p < 0.001). The optimal threshold of post-procedural MSA to predict follow-up MLA > or =4 mm(2) at the SB ostium was 4.83 mm(2), yielding an area under the curve of 0.88 (95% confidence interval: 0.80 to 0.95). CONCLUSIONS: Our data suggest that inadequate post-procedural MSA with increased neointimal hyperplasia may cause the SB ostium to be the most frequent site of restenosis after percutaneous coronary intervention on bifurcation lesions.
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