Assessment of Bifurcation Lesions Using Imaging Techniques (Angiography, IVUS, OCT)

Dr. Ali Sezgin1
Dr. Ayşe Avara2

1Ankara Etlik City Hospital, Department of Cardiology, Ankara, Türkiye
2Ankara Etlik City Hospital, Department of Cardiology, Ankara, Türkiye

ABSTRACT

Coronary artery bifurcation lesions are characterized by stenosis at the origin of the side branch from the main vessel, occurring in 15-20% of Percutaneous Coronary Interventions (PCI) in interventional cardiology. These lesions present a higher risk of complications compared to other PCI procedures due to anatomical challeng- es such as vessel angulation, calcification, and side branch angle. The decision to protect the side branch during the procedure often depends on the operator’s clinical judgment. Studies like SYNTAX have shown that bifurcation PCI is associated with increased mortality and complications. As a result, the use of pre-PCI imaging techniques (such as intravascular ultrasound, IVUS, or optical coherence tomography, OCT) is crucial in reducing risks and guiding treatment strategies. Coronary bifurcation anatomy consists of three main com- ponents: the main vessel, the distal main vessel, and the side branch. At the bifurcation point, the junction of these vessels forms what is known as a “The Polygon of Confluence.” This polygon plays a significant role in assessing lesion severity and determining the need for intervention. Conventional coronary angiography may not fully evaluate bifurcation lesions, making advanced imaging techniques like 3D Quantitative Coronary Angiography (QCA) more accurate in such cases. IVUS, an ultrasound-based method that examines the ves- sel walls, is vital for evaluating bifurcation lesions and determining treatment strategies by assessing vessel morphology and plaque burden. OCT, offering higher resolution, provides clearer imaging of stent placement and side branch patency. Additionally, computed tomography (CT) serves as a non-invasive method to assess vessel structure. The successful treatment of bifurcation lesions relies heavily on the use of these advanced imaging methods to ensure optimal outcomes.

Keywords: Percutaneous coronary intervention; Optical coherence tomography; Intravascular ultrasound; Coronary angiography; Computed tomography angiography

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