Division of Cardiology, Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine.
Department of Cardiology, Osaka Saiseikai Nakatsu Hospital.
Circ J. 2024 May 24;88(6):959-969. doi: 10.1253/circj.CJ-22-0723. Epub 2023 Oct 14.
Side branch (SB) occlusion during bifurcation stenting is a serious complication. This study aimed to predict SB compromise (SBC) using optical coherence tomography (OCT).
Among the 168 patients who enrolled in the 3D-OCT Bifurcation Registry, 111 bifurcation lesions were analyzed to develop an OCT risk score for predicting SBC. SBC was defined as worsening of angiographic SB ostial stenosis (≥90%) immediately after stenting. On the basis of OCT before stenting, geometric parameters (SB diameter [SBd], length from proximal branching point to carina tip [BP-CT length], and distance of the polygon of confluence [dPOC]) and 3-dimensional bifurcation types (parallel or perpendicular) were evaluated. SBC occurred in 36 (32%) lesions. The parallel-type bifurcation was significantly more frequent in lesions with SBC. The receiver operating characteristic curve indicated SBd ≤1.77 mm (area under the curve [AUC]=0.73, sensitivity 64%, specificity 75%), BP-CT length ≤1.8 mm (AUC=0.83, sensitivity 86%, specificity 68%), and dPOC ≤3.96 mm (AUC=0.68, sensitivity 63%, specificity 69%) as the best cut-off values for predicting SBC. To create the OCT risk score, we assigned 1 point to each of these factors. As the score increased, the frequency of SBC increased significantly (Score 0, 0%; Score 1, 8.7%; Score 2, 28%; Score 3, 58%; Score 4, 85%; P<0.0001).
Prediction of SBC using OCT is feasible with high probability.
边支（SB）闭塞是分叉支架置入术中的严重并发症。本研究旨在通过光学相干断层扫描（OCT）预测边支闭塞（SBC）。
在 3D-OCT 分叉登记研究中，纳入了 168 名患者，对其中 111 个分叉病变进行分析，建立 OCT 预测 SBC 的风险评分。SBC 定义为支架置入后即刻造影显示 SB 开口狭窄程度加重（≥90%）。根据支架置入前的 OCT，评估几何参数（SB 直径[SBd]、从近端分叉点到嵴尖的距离[BP-CT 长度]和汇合多边形的距离[dPOC]）和 3 维分叉类型（平行或垂直）。36 个（32%）病变发生 SBC。SBC 病变中平行型分叉更为常见。ROC 曲线显示 SBd≤1.77mm（曲线下面积[AUC]=0.73，敏感性 64%，特异性 75%）、BP-CT 长度≤1.8mm（AUC=0.83，敏感性 86%，特异性 68%）和 dPOC≤3.96mm（AUC=0.68，敏感性 63%，特异性 69%）为预测 SBC 的最佳截断值。为了创建 OCT 风险评分，我们将每个因素赋值 1 分。随着评分的增加，SBC 的发生率显著增加（评分 0：0%；评分 1：8.7%；评分 2：28%；评分 3：58%；评分 4：85%；P<0.0001）。
使用 OCT 预测 SBC 具有较高的可能性。
