Bifurcation percutaneous coronary intervention of left main trunk treated using a proximal optimizing technique and proximal balloon edge dilation technique.

We present a case of bifurcation percutaneous coronary intervention (PCI) of the left main trunk (LMT) using a proximal balloon edge dilation (PBED) technique following a proximal optimizing technique (POT). The procedure of the PBED technique entailed precise positioning of the balloon for SB dilation, with the proximal radiopaque marker lying in the cross-sectional plane of the stent struts at the left circumflex artery (LCx) ostium. The PBED technique might prevent stent deformation induced by side branch (SB) dilation and eliminates the need for the second POT procedure in the re-POT sequence. In fact, three-dimensional reconstruction of optical coherence tomography (3D-OCT) revealed good opening of stent cells overlying the LCx ostium without deformation of stent struts causing incomplete stent apposition at the site opposite the LCx, so the second POT procedure was unnecessary in this case. .

Acute coronary syndrome demonstrating plaque rupture in calcified plaque visualized by optical coherence tomography and near-infrared spectroscopy combined with intravascular ultrasound.

Optical coherence tomography (OCT) can visualize calcification of the coronary plaque as a low-intensity lesion with sharp borders. However, residual lipid tissue inside the calcification could pose a problem in plaque evaluation by OCT. We present a case of acute coronary syndrome (ACS) demonstrating plaque rupture in the calcified plaque. In this case, OCT demonstrated a cavity suspected to represent rupture in the calcified plaque and near-infrared spectroscopy revealed a lipid component behind the calcified plaque. Although calcified plaque is not considered a reason for ACS except for calcified nodules, residual lipid tissue inside the calcification might cause ACS if the thin fibrous cap over the lipid tissue is disrupted, even if surrounded by calcification. .

Neointimal coverage of jailed side branches in coronary bifurcation lesions: an optical coherence tomography analysis.

OBJECTIVES: The jailed strut at the side-branch (SB) orifice may be a cause of delayed neointimal coverage and SB flow disturbance after single stenting to bifurcation. The aim of this study was to characterize the exact relationship between the jailed strut pattern at the SB orifice immediately after stent implantation and neointimal coverage of the jailed SB orifice in the chronic phase. PATIENTS AND METHODS: A total of 29 bifurcation (left anterior descending coronary artery and diagonal branch) lesions treated by optical coherence tomography-guide single-stent implantation and followed at 18 months after a percutaneous coronary intervention were included in this study. RESULTS: Using three-dimensional optical coherence tomography images, the jailed stent strut pattern was classified into two groups on the basis of the presence of a stent strut link at the SB orifice (link group: n=11, and no-link group: n=18). SB orifice obstruction by neointima was significantly greater in the link group than in the no-link group during the 18-month follow-up period (26.8±21.9 vs. 9.5±22.1%, P=0.049). CONCLUSION: This single-center observational study with a small sample size showed that a jailed strut pattern at the SB orifice might be related to neointimal coverage of the SB orifice in bifurcation lesions treated with single-stent implantation. Further large-scale studies with long-term follow-up will be necessary to determine the exact relationship between the jailed strut pattern at the SB orifice and SB flow disturbance because of delayed neointimal coverage as well as clinical outcome.