TheinfluenceofbifurcationangleontherePOTsequence

DepartmentofCardiologyandInterventionalCardiologyCardiovascularHospital- HospicesCivilsdeLyonINSERMResearchUnit1060CarMeNClaudeBernardUniversityLyon1Lyon- France

XIIEuropeanBifurcationClubmeeting– Rotterdam– October2015

GérardFINET,MDPhDFrançoisDERIMAY,MD

carena- plaque-freesegment- thin- potentialymovable- oppositetoplaquegrowth

carena

carenashifting

Radialstrainmapduringstentimplantation

bifangle

Bifurcationangleandcarenashifting

FinetGetOhayonJ(EBC2012)

Courtesy:DrR.Virmani

30°-bifangle 60°-bifangle 90°-bifangle

LinearfractalratioDmother-vessel =0.678(Ddaughter-vessel1 +Ddaughter-vessel2)

b =a1+a2a1

a1

DMoV =4.25mmDMB =3.25mm

DSB =2.9mm

a1 a1 b

BenchA 20° 10° 30°

BenchB 20° 40° 60°

BenchC 20° 70° 90°

Newfractalbifurcationbenchmodelswithdifferentbifurcationangle

Fractalbifurcationbenchmodel90° bifurcationangle

rePOT POT+KBcomplete

balloonjuxtaposition

POT+KBminimal

balloonjuxtaposition

DrefMoV/DstentedMoV /SARMoV 4.29/4.28mm/1.0 4.21/4.38mm/1.01 4.23/4.30mm/1.01

Ellipticalratio 1.03 1.19 1.04

DrefMB /DMB/SARMB 3.26/3.40mm/1.04 3.28/3.53mm/1.07 3.25/ 3.45mm/1.06

DMBostium 3.83mm 3.46mm 3.60mm

DdistalMOV /ellipticratio 4.13mm/1.04 4.36mm/1.21 4.23mm/1.18

DstentedMoVSARMoVEllipticalratio

SBobstruction

DMBostium

DMBSARMB

D distalMoVEllipticalratio

DrefMoV

DrefMB

Fractalbifurcationbenchmodel60° bifurcationangle

rePOT POT+KBcomplete

balloonjuxtaposition

POT+KBminimal

balloonjuxtaposition

DrefMoV/DstentedMoV/SARMoV 4.07/4.23mm/1.03 4.07/4.40mm/1.04 4.27/4.45mm/1.01

Ellipticratio 1.03 1.19 1.01

DrefMB /DMB/SARMB 3.18/3.44mm/1.08 3.27/3.46mm/1.10 3.24/3.49mm/1.07

mean DMB ostium 3.93mm 3.60mm 3.52mm

DdistalMOV /ellipticratio 4.17mm/1.05 4.37 mm/1.20 4.28mm/1.09

DstentedMoVSARMoVEllipticalratio

SBobstruction

DMBostium

DMBSARMB

D distalMoVEllipticalratio

DrefMoV

DrefMB

Fractalbifurcationbenchmodel30° bifurcationangle

rePOT POT+KBcomplete

balloonjuxtaposition

POT+KBminimal

balloonjuxtaposition

DrefMoV/DstentedMoV/SARMoV 4.30/4.30mm/1.0 4.24/4.41mm/1.03 4.33/4.39mm/1.01

Ellipticratio 1.04 1.28 1.05

Dref /DMB/SARMB 3.35/3.55mm/1.05 3.24/3.52mm/1.07 3.18/3.42mm/1.07

mean DMB ostium 3.92mm 3.50mm 3.50mm

DdistalMOV /ellipticratio 4.28mm/1.09 4.43mm/ 1.26 4.32/1.12

DstentedMoVSARMoVEllipticalratio

SBobstruction

DMBostium

DMBSARMB

D distalMoVEllipticalratio

DrefMoV

DrefMB

ImmediateinvivoassessmentofrePOTsequenceinprovisionalcoronarystentingSerialOCTanalysis

InfluenceofMedinaclassification100bifurcations 1-0-0

n=13(13%)010– 110– 010n=42(42%)

001– 101– 011n=18(18%)

111n=27(27%)

Afterstent implantation

a° bif angle 70± 26° 67±18° 66±23° 74±18°

MeanDMoV 3.76± 0.78mm 3.76±0.69mm 3.6±0.6 mm 3.65±0.51mm

Meanstent D 3.08± 0.58mm 3.10±0.55mm 3.02±0.51mm 2.98±0.35mm

∆D(proximalunderexpansion)

0.67± 0.57mm 0.60±0.44 mm 0.58±0.39mm 0.67±0.41mm

SBOobstruction 37.63± 18.55% 34.54±22.91% 29.1±25.9% 38.31±25.15 %

AfterrePOTsequence

meanDMoV /SARMoV 3.73±0.61mm0.94±0.38

3.94±0.701.04±0.08

3.80±0.641.08±0.07

3.77±0.52mm1.03±0.1

meanDMB/SARMB 3.16±0.58mm0.95±0.39

3.08±0.551.09±0.19

2.86±0.511.04±0.08

2.97±0.51mm1.05±0.1

SBOobtruction% 17.0±18.7 % 11.73±16.57% 12.28±21.24% 10.44±12.6%

Finalglobalstrutmalapposition(%)

6.4±5.4% 2.8±3.08% 2.91±3.3% 2.77±4.2

100bifurcations a° :20° - 40°n=17(17%)

a° :45° - 70°n=35(35%)

a° :80° - 110°n=48(48%)

Afterstent implantation

MeanDMoV 3.73± 0.65mm 3.38±0.52mm 4.13±0.67mm

Meanstent D 3.08± 0.51mm 2.95±0.49mm 3.14±0.57mm

∆D(proximalunderexpansion)

0.59± 0.34mm 0.43±0.37mm 0.84±0.39mm

SBOobstruction 38.9± 21.3% 34.2±22.3 % 33.3±24.8

AfterrePOTsequence

SARMoV 1.03± 0.06 1.02± 0.24 1.01± 0.13

SARMB 1.0± 0.12 1.07± 0.28 1.05± 0.11

SBO% 13.2± 15.0% 23.1± 22.1% 9.84± 12.5%

Globalstrutmalpposition(%)

2.71±2.76% 2.52± 2.37% 4.05± 4.88%

ImmediateinvivoassessmentofrePOTsequenceinprovisionalcoronarystentingSerialOCTanalysis

Influenceofbifurcationanglebetweentwodaughtervessels

Summary

Theoretically bifurcation angle plays a negative role in the treatment ofbifurcation with provisional stenting

This negative role increases as the cosinus of the bifurcation angle, thisrelationship is curvilinear and becomes major for small angles close to 30 °

However:1) in fractal bifurcation bench models, rePOT sequence produces rather

constant results if the precise positioning of the POT balloon is welldone,

1) in clinical study with OCT analysis, bifurcation angles do not influencethe final morphological results after rePOT sequence