Assessment of coronary bifurcation stenting using optical coherence tomography

Introduction: Percutaneous coronary intervention (PCI) in coronary bifurcation lesions (CBL) is challenging and has poorer outcomes compared to non-bifurcation lesions. Conventional angiography alone is insufficient to assess procedural results because of poor resolution and complex anatomy involving bifurcations. We evaluate the use of optical coherence tomography (OCT) during bifurcation PCI to evaluate procedural results. Methods: This single-center, prospective, observational study included 13 patients with 14 CBLs undergoing PCI (one-stent or two-stent strategy) who were evaluated with OCT. After stent placement, OCT was used to assess acute stent malapposition, underexpansion, stent edge dissection, tissue protrusion, and microthrombi. To study malapposition in detail, bifurcation region was divided into four segments (proximal, distal and bifurcation segments of main vessel and side-branch segment). Results: The overall incidence of stent malapposition was 64%. It was more common with two-stent strategy compared to one-stent strategy (83% vs 50%). The incidence of malapposition was highest in side-branch and least in distal segment of main vessel. Stent underexpansion was seen in 21% of cases. Stent edge dissection, microthrombi, tissue prolapse were noted in 21% of cases. OCT findings led to additional interventional steps in 38% of cases. Conclusions: OCT can be used to comprehensively assess procedural results after bifurcation stenting. The incidence of acute stent malapposition is high after stenting at bifurcation sites and is more common when the two-stent techniques are used compared to the one-stent technique. Whether long-term clinical outcomes are affected by findings uncovered on OCT needs to be studied in prospective trials.