Department of Cardiology, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan.
PLoS One. 2022 Aug 17;17(8):e0273157. doi: 10.1371/journal.pone.0273157. eCollection 2022.
A coronary bifurcation stenting is still a challenging issue due to frequent restenosis and stent thrombosis even with drug-eluting stents. The bifurcation angle (BA) between a main vessel and a side branch is one of the crucial determinants of coronary flow and shear stress that affect the plaque distribution. Previous bench and clinical studies have evaluated the impact of the BA between the proximal main vessel and the side branch (Angle A) and the BA between the distal main vessel and the side branch (Angle B) on the clinical outcomes of bifurcation stenting. However, the impact has not yet been fully elucidated due to a lack of statistical power or different manner of the assessment of BA.
To analyze the published studies on coronary artery BA, the modalities used for assessment, and the impact of BA on interventions and attempt to define the pre-procedural protocols.
A scoping review was performed using the Joanna Briggs Institute Methodology. A total of 52 relevant references were selected from PubMed, Cochrane Library, and CINAHL databases and categorized into three topic areas.
A wider Angle A is associated with the increased likelihood of carina shift and a wider Angle B, with that of side branch occlusion. A wider Angle B promotes stent malapposition and deformation in the side branch ostium and has been reported as an independent predictor of major adverse cardiac events after bifurcation stenting; however, improvement of the drug-eluting stent, refinement of the stenting technique, and accurate 3-dimensional assessment may attenuate the adverse clinical impact of a wider BA.
Assessment of the BA is necessary to predict the effect of bifurcation intervention procedure on the stent configuration and coronary flow at the bifurcated vessels. This will help to optimize stent selection and the stenting technique.
即使使用药物洗脱支架，冠状动脉分叉支架置入术仍然是一个具有挑战性的问题，因为其存在频繁的再狭窄和支架内血栓形成。主血管和分支血管之间的分叉角（BA）是影响斑块分布的冠状动脉血流和剪切力的关键决定因素之一。以前的台架和临床研究已经评估了主血管近端和分支血管（角 A）以及主血管远端和分支血管（角 B）之间的 BA 对分叉支架置入术临床结果的影响。然而，由于统计效力不足或 BA 评估方式不同，其影响尚未完全阐明。
分析已发表的关于冠状动脉 BA 的研究，评估 BA 的方法以及 BA 对介入治疗的影响，并尝试确定术前方案。
使用 Joanna Briggs 研究所方法进行了范围审查。从 PubMed、Cochrane 图书馆和 CINAHL 数据库中总共选择了 52 篇相关参考文献，并分为三个主题领域。
角 A 越大，出现嵴移位的可能性越大，角 B 越大，分支血管闭塞的可能性越大。角 B 越大，支架在分支血管开口处的贴壁不良和变形越明显，并且已被报道为分叉支架置入术后主要不良心脏事件的独立预测因素；然而，药物洗脱支架的改进、支架置入技术的精细化和准确的三维评估可能会减轻较大 BA 的不良临床影响。
评估 BA 对于预测分叉介入程序对分叉血管支架结构和冠状动脉血流的影响是必要的。这将有助于优化支架选择和支架置入技术。
