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Side Branch Occlusion Determinants in Bifurcation Lesions Treated with Provisional Stenting Technique

Betul Ozaltun

It is well known that because of turbulence flow and shear stress, bifurcation sites of coronary arteries are vulnerable to atherosclerotic disease. Bifurcation lesions comprise 15% to 20% of all coronary lesions. Bifurcation lesions are treated by either using provisional or double stent technique. The main drawback of provisional stenting is side branch occlusion. We aimed to investigate the predictors of side branch occlusion in provisional stenting technique. We enrolled 803 patients (231 female, 572 male, average age 60.5 ± 12.0) whose bifurcation coronary lesions treated by provisional stenting in Adana Numune Education and Training Centre. Demographic, angiographic and interventional data’s are recorded. 182 patients (22.7%) admitted to hospital with stable angina and 621 (77.3%) with acute coronary syndrome (or unstable angina). 582 (72.5%) patients had left anterior descending artery, 166 (20.7%), circumflex and 55 (6.8%) right coronary artery as the culprit vessel. Side branch occlusion occurred in 52 patients (6.5%). Need for side branch intervention occurred in 160 patients. The predictors of need for side branch intervention were, multivessel disease, type of main branch stent, oversize of stent, presence of side branch disease before intervention, TIMI frame count (TFC) and the alpha angle. In conclusion multivessel disease, type of main branch stent, oversize of stent, presence of side branch disease before intervention, TIMI frame count (TFC) and the alpha angle were independent predictors of need for side branch intervention.