Carina Shift as a Mechanism for Sidebranch Compromise Following Main Vessel Intervention: Insights From Three-Dimensional Optical Coherence Tomography

OBJECTIVES: Three-dimensional rendering of optical coherence tomography (OCT) images is a method that can be used for providing additive information for assessing the result of percutaneous coronary intervention (PCI), especially in complex lesions such as in bifurcations. While plaque shift has been considered the main underlying mechanism for side-branch compromise after suggest carina shift to be a major contributor. We present a case were on-line three-dimensional OCT was used to demonstrate the role of carina shift in side-branch pinching, following main vessel intervention.

METHODS: In our case, we used OCT in order to evaluate the preprocedural morphology of the main vessel and the side-branch, and based on our findings, opted to use a provisional stenting strategy with a relatively long stent in order to treat this diffusely diseased vessel.

RESULTS: Post-procedural evaluation guided the use of post-dilation. Additionally, 3-dimensional OCT visualized the spiky carina morphology that was free of atheromatic disease, and illustrated how carina shift towards the side-branch led to moderate angiographic narrowing of the side-branch ostium. Our case demonstrates how OCT constitutes a valuable tool for PCI guidance and also the utility of 3-dimensional renderings for assessing the mechanism of side-branch compromise following intervention in bifurcation lesions.

CONCLUSIONS: This might guide clinical decision making in the future with OCT three-dimensional rendering becoming available in realtime in the cathlab. 

PMID:

Posted in Invasive Imaging and tagged , , , , , .

One Comment

  1. See:

    Carina shift as a mechanism for side-branch compromise following main vessel intervention: Insights from three-dimensional optical coherence tomography.
    Antonios Karanasos, Shengxian Tu, Elco van der Heide, Johan HC Reiber, Evelyn Regar.
    Cardiovasc Diagn Ther. May 8, 2012.
    http://www.amepc.org/cdt/article/view/633/678

    And

    Carina Shift and Plaque Shift in the Side Branch Ostial Compromise During the Bifurcation Stenting: Volumetric Intravascular Ultrasound Analysis of Both Main and Side Branches.
    Jianqiang Xu, Young Bin Song, Joo Yong Hahn, Jin-Ho Choi, Seung Hyuk Choi, Sang Hoon Lee, Kyung Pyo Hong, Jung Euy Park, Hyeon-Cheol Gwon, Cardiac and Vascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
    Journal Of American Clinical Cardiology. April 5, 2011. 57(14).
    http://content.onlinejacc.org/cgi/reprint/57/14_Suppl_S/E1654.pdf

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