THE EFFICACY OF INTRAVASCULAR IMAGING METHODS IN THE MANAGEMENT OF PATIENTS WITH “FALSE” LEFT MAIN BIFURCATION LESIONS: 12-MONTH FOLLOW-UP RESULTS

Highlights

• Despite the longstanding use of intravascular imaging methods, patients presenting with “false” bifurcation lesions of the left main coronary artery have traditionally been excluded from observational studies. The study presents results on the safety and efficacy outcomes of percutaneous coronary intervention guided by intravascular imaging in this patient cohort. Over a 12-month follow-up period, intravascular ultrasound and optical coherence tomography demonstrated comparable safety and efficacy profiles, while post-procedural fractional flow reserve measurement showed additional clinical utility.

Abstract

Aim. To evaluate the efficacy and safety of percutaneous coronary interventions using intravascular methods in patients with “false” bifurcation lesions of the left main coronary artery.

Methods. The study enrolled 162 patients with angiographically confirmed “false” bifurcation lesions of the LMCA. Participants were randomized into two groups using the envelope method, based on the selected imaging technique. In Group 1 (n = 81), intravascular ultrasound (IVUS) was performed, while Group 2 (n = 81) underwent optical coherence tomography (OCT). Following imaging and per inclusion criteria, 128 patients were ultimately included in the analysis. Patients with a minimal lumen area (MLA) < 6 mm² in the distal LMCA underwent myocardial revascularization. In cases where MLA > 6 mm² and fractional flow reserve (FFR) > 0.8 (n = 36), revascularization was deferred, and medical therapy was recommended. Provisional stenting was performed in both groups, with subsequent FFR measurement in both the main and side branches, as well as stent assessment using IVUS or OCT. If FFR in a native branch was < 0.8, a second stent was deployed using either the "reverse-crush" or "reverse-Culotte" technique. If FFR was > 0.8, the procedure was considered complete.

Results. At 12-month follow-up, in-stent restenosis occurred in 2.0% and 4.8% of patients in Groups 1 and 2, respectively (p = 0.590). Restenosis in the side branch was observed in 6.0% and 4.8% of patients (p = 1.000). Target lesion revascularization was performed in 2.0% of Group 1 patients (p = 0.489). Myocardial infarction (MI) was recorded in 8.0% of patients in Group 1 (p = 0.122), with stent thrombosis at the target lesion site being the cause in 4.0% (p = 0.498), and 2.0% of these cases proving fatal. Other MIs were attributable to lesions in non-target coronary arteries. Cardiac mortality was exclusively observed in Group 1, at 4.0% (p = 0.186). The cumulative incidence of major adverse cardiac events (MACE) was higher in Group 1 compared to Group 2, at 10.0% and 2.4%, respectively (p = 0.214).

Conclusion. The use of IVUS or OCT demonstrates equivalent efficacy in optimizing clinical outcomes for patients with “false” bifurcation lesions of the LMCA. Postprocedural FFR measurement facilitates the timely detection of residual ischemia and enables dynamic intraoperative decision-making, significantly enhancing the safety and effectiveness of PCI.

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