Yonsei Med J.  2016 May;57(3):606-613. 10.3349/ymj.2016.57.3.606.

Serial Morphological Changes of Side-Branch Ostium after Paclitaxel-Coated Balloon Treatment of De Novo Coronary Lesions of Main Vessels

• Her AY
• Ann SH
• Singh GB
• Kim YH
• Okamura T
• Garg S
• Koo BK
• Shin ES

• KMID: 2374078
• DOI: http://doi.org/10.3349/ymj.2016.57.3.606

Abstract

PURPOSE
The effects on the side-branch (SB) ostium, following paclitaxel-coated balloon (PCB) treatment of de novo coronary lesions of main vessels have not been previously investigated. This study was aimed at evaluating the serial morphological changes of the SB ostium after PCB treatment of de novo coronary lesions of main vessels using optical coherence tomography (OCT).
MATERIALS AND METHODS
This prospective, single-center observational study enrolled patients with de novo lesions, which were traversed by at least one SB (≥1.5 mm) and were treated with PCB. The SB ostium was evaluated with serial angiographic and OCT assessments pre- and post-procedure, and at 9-months follow-up.
RESULTS
Sixteen main vessel lesions were successfully treated with PCB, and 26 SBs were included for analysis. Mean SB ostial lumen area increased at 9-months follow-up (0.92±0.68 mm2 pre-procedure, 1.03±0.77 mm2 post-procedure and 1.42±1.18 mm2 at 9-months). The SB ostial lumen area gain was 0.02±0.24 mm2 between pre- and post-procedure, 0.37±0.64 mm2 between post-procedure and 9-months, and 0.60±0.93 mm2 between pre-procedure and 9-months. The ostial lumen area increased by 3.9% [interquartile range (IQR) of -33.3 to 10.4%] between pre- and post-procedure, 52.1% (IQR of -0.7 to 77.3%) between post-procedure and 9-months and 76.1% (IQR of 18.2 to 86.6%) between pre-procedure and 9-months.
CONCLUSION
PCB treatment of de novo coronary lesions of main vessels resulted in an increase in the SB ostial lumen area at 9-months.

Keyword

Paclitaxel-coated balloon; de novo coronary lesion; main vessel; side-branch ostium; optical coherence tomography

MeSH Terms

Aged
Angioplasty, Balloon, Coronary/*methods
Coronary Angiography
Coronary Stenosis/diagnosis/*therapy
Coronary Vessels/*pathology
*Drug-Eluting Stents/adverse effects
Female
Humans
Male
Middle Aged
Paclitaxel/*administration & dosage
Prospective Studies
Tomography, Optical Coherence/*methods
Treatment Outcome
Tubulin Modulators/administration & dosage
Paclitaxel
Tubulin Modulators

Figure

• 

  Fig. 1 Pre-procedure (A), post-procedure (B) and follow-up angiographic images (C) coupled to corresponding OCT images. OCT images were captured in corresponding segments through main vessel (D and G) and SB (E, F, H, and I) (i.e., same OCT segment is depicted between post-procedure, and follow-up) by means of a software synchronization tool. Pre-procedure angiographic image shows a true bifurcation lesion. After the procedure, the OCT image demonstrates dissection of main vessel, and SB ostium shows compromise from the dissected flap of the main vessel (D). At follow-up, the lumen area of the main vessel (G and H) and SB ostium (H and I) increases further due to the drug effect. The dissections as seen on OCT at the SB ostium have healed (G). The arrows and asterisks represent SB ostium. OCT, optical coherence tomography; SB, side-branch.

• 

  Fig. 2 Method of analysis of the SB ostium. Simpson's rule is an approximation method for calculating the area of an irregular shape. In (A), the approximate area is found by the formula: A=h/3 (df+4 dm+dl), where h=distance between successive measurements, df=first measurement, dm=middle measurement, dl=last measurement. In (B), the Simpson's rule can be derived by approximating the integrand f (x) by the quadratic interpolant P (x). We measured cross-sectional length of SB ostium with a 0.2 mm interval on still frame of OCT images (C) and calculated the lumen area of SB ostium using application of Simpson's rule (a=initial point of measurement at the intersection, b=end point of measurement at the intersection). SB, side-branch; OCT, optical coherence tomography.

• 

  Fig. 3 Study diagram of the present study. OCT, optical coherence tomography; PCB, paclitaxel-coated balloon; SB, side-branch.

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  Fig. 4 The changes in the main vessel lumen area (A) and the SB ostial lumen area (B) pre-procedure, post-procedure and at 9-months follow-up. SB, side-branch.

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