LM-Bifurcation PCI: Stent Design and the Effects of Cardiac Flow

Robert S. Schwartz, MD, FACC, FAHA, FSCAI, FSCCT
Minneapolis Heart Institute and Foundation

Left main coronary artery stenting is commonplace in today’s PCI, but new questions arise as to safety. Specifically, the three-dimensional changes in space as the left main and its bifurcation change throughout the cardiac cycle have the capability of bringing novel stresses onto today’s thin metallic stents.
We believed it was important to understand this three-dimensional movement throughout the cardiac cycle, with special attention to the bifurcation angle. We took advantage of modern-day three-dimensional CTA imaging to help answer this question of bifurcation angles and their changes through time.
We first found marked absolute angle variability across patients. We then quantitated these numbers for reference and understanding which stents may in fact perform better for left main PCI. Interestingly, these angles had small angulation changes resulting from the cardiac cycle movement, suggesting less stringent requirements for stent torsion.
These results are clearly reassuring regarding left main PCI and our ability to stent this area with multiple stent designs. At this point, growing experience with left main stenting confirms the safety of modern-day stents in left main disease reasonably independent of stent design.

Read the entire study in this month’s Journal of Invasive Cardiology:

The Left Main Bifurcation Angle and Changes Throughout the Cardiac Cycle: Quantitative Implications for Left Main Bifurcation Stenting and Stents
Chauncy B. Handran, MD; Ross F. Garberich, MD; John R. Lesser, MD; Timothy D. Henry, MD; Michael Gilmore; Robert B. Schwartz, MD
J INVASIVE CARDIOL 2015;27(9):401-404. Epub 2015 May 15

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