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Keywords:
Cardiac, Cardiovascular system, CT-Angiography, CT, Comparative studies, Computer Applications-Detection, diagnosis, Image verification
Authors:
H. Eom, D. H. Yang, Y.-H. Kim, J. Kwon, J.-H. Roh, J.-W. Kang, T.-H. Lim; Seoul/KR
DOI:
10.1594/ecr2015/C-1924
Aims and objectives
Percutaneous coronary intervention for coronary bifurcation lesions has been associated with lower procedural success rates and worse clinical outcome compared with nonbifurcation lesions in the bare stent era (1).
However,
after the introduction of drug-eluting stents,
extremely low rates of in-stent restenosis have been observed (2).
Following several randomized controlled studies have indicated that coronary bifurcation lesions may be optimally treated using the optional side branch stenting strategy and the clinical outcomes after simple optional side branch stenting remained at least equal to the more complex strategy of planned stenting of both the main vessel and the side branch (3-7).
There are various techniques for bifurcation lesions and Crush or Culotte stenting are widely accepted techniques (8).
Crush or Culotte stenting theoretically provides full scaffolding of the side branch (SB) ostium,
but these approaches are associated with greater strut malapposition and higher rates of target lesion revascularization and myocardial infarction than provisional stenting (9).
Studies including intravascular ultrasound assessment and in vitro bench deployment using micro computed tomography (CT) imaging have shown post-bifurcation stent morphology (9-12).
Unfortunately,
identifying post-stenting morphology using noninavasive modality has not been studied.
Coronary CT angiography has been reported to show promising results in luminal patency and stent fracture (13-15).
Lim and colleagues found that coronary CT angiography depicts stent fractures in patients and phantoms,
even those fractures that are not clearly depicted by conventional angiography (15).
Based on the idea that CT angiography could demonstrate mechanical changes in stents,
we hypothesized that post-bifurcation stent morphology evaluation could be possible on coronary CT angiography.
Accordingly,
we designed we designed out study to analyze post-bifurcation stent morphology in vitro on dual-source CT and validate those findings using micro-CT.