Prediction of side branch occlusion in bifurcational lesions during percutaneous coronary interventions by preprocedural coronary computed tomography using the CT bifurcation score.

INTRODUCTION

Coronary computed tomographic angiography (CCTA) is a highly diagnostically accurate non-invasive imaging method for a thorough evaluation of atherosclerotic plaques. Many CCTA-based imaging investigations concentrate on bifurcation lesions.

AIM

To determine whether intraprocedural side branch (SB) obstruction during the percutaneous coronary intervention (PCI) of lesions involving bifurcations might be predicted by preprocedural CCTA.

MATERIAL AND METHODS

This retrospective observational study was conducted on 200 stentable bifurcation lesions of 200 coronary artery disease patients with the SB ≥ 2 mm in diameter. All patients were planned for elective bifurcation PCI after undergoing CCTA for quantitative plaque characterization of both the main vessel and SB to obtain the CT bifurcation score. Then, angiography-based bifurcations were classified using both the Medina classification and the RESOLVE score before PCI of the bifurcation lesions. Most of the cases were managed by the provisional technique.

RESULTS

The CT bifurcation score was substantially higher in patients with SB occlusion ( < 0.001) with 80% sensitivity and 60% specificity at a cut-off point of 3. There was a borderline significant relation between the Medina score and SB occlusion in the studied cases ( = 0.05) with 60% sensitivity and 40% specificity. The RESOLVE score was unexpectedly an insignificant predictor of SB occlusion ( = 0.25) in our study, with 40% sensitivity and 50% specificity.

CONCLUSIONS

Intraprocedural SB occlusion can be predicted by a comprehensive CCTA evaluation. The CT bifurcation score, a novel and simple points scoring system based on six CCTA parameters, outperformed current angiographic classification or scoring systems for predicting SB occlusion.