Hemodynamic impact of changes in bifurcation geometry after single-stent cross-over technique assessed by intravascular ultrasound and fractional flow reserve

Catheter Cardiovasc Interv. 2013 Dec 1;82(7):1075-82. doi: 10.1002/ccd.24956. Epub 2013 Aug 1.


Background: Angiographic stenosis of a sidebranch (SB) ostium is common after single-stent cross-over, but it is usually not hemodynamically significant. We evaluated the relationship between the mechanisms of SB stenosis and its hemodynamic significance.

Methods and results: We used preinterventional and post-interventional intravascular ultrasound (IVUS) of the main branch (MB) and the SB and post-intervention fractional flow reserve (FFR) of the SB to assess 40 nonleft main bifurcation lesions after a single stent cross-over. Although post-stenting angiographic diameter stenosis >50% was seen in 19 (48%) SB lesions, only 6 (15%) showed FFR < 0.80. Carina shift was seen in all but one lesion; and plaque shift superimposed on the carina shift was found in 18 (45%) lesions. The change in plaque area at the SB ostium positively correlated with preprocedural plaque burden at the carina of distal MB r = 0.341, P = 0.031). Plaque shift was more common in lesions with FFR < 0.80 vs. ≥0.80 (83% vs. 38%, P = 0.041); and FFR < 0.80 was more frequent in lesions with plaque shift superimposed on carina shift versus isolated carina shift (28% vs. 5%, P = 0.041).

Conclusions: Although carina shift was the main mechanism of SB lumen loss after a single stent cross-over technique, plaque shift superimposed on carina shift appeared to be necessary to cause a hemodynamically significant stenosis (FFR < 0.80). However, post-procedural IVUS assessment did not accurately predict the functional significance.

Keywords: carina shift; fractional flow reserve; intravascular ultrasound; plaque shift.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Coronary Angiography
  • Coronary Artery Disease / diagnosis
  • Coronary Artery Disease / physiopathology
  • Coronary Artery Disease / therapy*
  • Coronary Stenosis / diagnosis*
  • Coronary Stenosis / diagnostic imaging
  • Coronary Stenosis / etiology
  • Coronary Stenosis / physiopathology
  • Coronary Vessels / diagnostic imaging*
  • Coronary Vessels / physiopathology*
  • Female
  • Fractional Flow Reserve, Myocardial*
  • Hemodynamics*
  • Humans
  • Male
  • Middle Aged
  • Percutaneous Coronary Intervention / adverse effects
  • Percutaneous Coronary Intervention / instrumentation*
  • Percutaneous Coronary Intervention / methods
  • Plaque, Atherosclerotic
  • Predictive Value of Tests
  • Stents*
  • Time Factors
  • Treatment Outcome
  • Ultrasonography, Interventional*