The Carina Angle-New Geometrical Parameter Associated with Periprocedural Side Branch Compromise and the Long-Term Results in Coronary Bifurcation Lesions with Main Vessel Stenting Only

Methods: Eighty-four patients formed the study population. The inclusion criteria were good-quality angiograms, with maximal between-branch angle opening, no overlap, permitting accurate angiographic analysis. Carina angle (alpha)-the distal angle between main vessel (MV) before bifurcation and side branch (SB)-was measured pre- and poststenting. Clinical follow-up 9-12 months was obtained with coronary angiography if needed. Results: The patient population was high-risk with 33% diabetics and 84% two- and three-vessel disease. Ninety-five stents were implanted in 92 lesions, with three T-stenting cases. Drug-eluting stents were implanted in 54%. Kissing-balloon (KBI) or sequential inflation was performed in 35%. SB functional closure occurred in 17.4%, with independent predictors alpha < 40 degrees and diameter ratio MB/SB > 1.22. After 12 +/- 4 months there were five myocardial infarctions (6%) and 13 (15%) target lesion revascularization procedures. Independent predictors of major cardiovascular events were carina angle < 40 degrees, MB lesion length > 8 mm, negative change of between-branch angle, DES usage, and KBI. Conclusions: Smaller carina angle with straightening of MV-main branch from stent implantation in coronary bifurcations predicted higher SB compromise, restenosis, and MACE rates during follow-up of 1 year. (J Interven Cardiol 2009;22:E1-E10).