Ultrasound Findings During Percutaneous Treatment of Bifurcated Coronary Lesions

Introduction and objectives. Provisional stenting has been shown to be effective in the treatment of bifurcated coronary lesions. The aim of this study was to evaluate changes in the geometry of the main vessel stent following side branch (SB) dilatation and kissing balloon (KB) inflation. Methods. The study involved 23 patients with a bifurcated coronary lesion. A first intravascular ultrasound (IVUS) study was performed after drug-eluting stent implantation in the main vessel. Subsequently, angioplasty of the SB was carried out, and a second IVUS was performed to evaluate its effect. Finally, KB inflation was carried out, followed by a third IVUS study of the main vessel. The cross-sectional area of the implanted stent at different points was compared in the three IVUS studies. Results. The cross-sectional area of the proximal segment of the recently implanted stent was 7.3 +/- 1.9 mm(2) and increased to 9.6 +/- 2.9 mm(2) after KB inflation (P<.05). Dilatation of the SB resulted in a reduction in the cross-sectional area under the SB origin from 5.9 +/- 12 mm(2) initially to 5.2 +/- 1.2 mm(2) (P<.05). After KB inflation, the cross-sectional area partially recovered (to 5.6 +/- 1.2 mm(2)). Conclusions. After angioplasty of the SB, a reduction was observed in the cross-sectional area of the stent immediately distal to the SB origin. The area did not return to its initial value after KB inflation. However, KB inflation increased the cross-sectional area of the proximal segment of the stent and changed stent geometry.