The left main bifurcation angle and changes throughout the cardiac cycle: Quantitative implications for left main bifurcation stenting and stents

Chauncy B. Handran, Ross F. Garberich, John R. Lesser, Timothy D. Henry, Michael Gilmore, Robert B. Schwartz

Research output: Contribution to journalArticlepeer-review

2 Scopus citations

Abstract

OBJECTIVE: The objective of this study was to quantify the left main (LM) bifurcation angles and their changes throughout the cardiac cycle. BACKGROUND: LM stenting is an accepted alternative to coronary artery bypass grafting. However, the LM bifurcation has great anatomic variability. Three-dimensional angles and their cyclic changes are important for coronary stenting. METHODS: Patients undergoing coronary computed tomography angiography (CCTA) for chest pain were scanned and analyzed in three-dimensional views for left main-left anterior descending (LM-LAD), left main-left circumflex (LM-LCX), and left anterior descending-left circumflex (LAD-LCX) angles and their cyclic changes. Calculations and assessment of angles, angular variability, and how these angles change throughout the cardiac cycle were analyzed. RESULTS: Forty-four patient scans were analyzed. The median end-diastolic LM-LCX angle was 130° and the LAD-LCX was 74°. Median end-systolic angle for the LM-LCX was 133°, and LAD-LCX was 69°. Large differences were found across all three absolute angles (LM-LCX, LAD-LCX, LM-LAD). Marked variability also occurred in how these angles changed throughout the cardiac cycle. CONCLUSIONS: LM bifurcation geometry in patients shows marked absolute angle variability, as does diastolic-systolic angle movement. LM bifurcation stents should accommodate wide interpatient bifurcation angles at rest for both the LM-LAD and LM-LCX angles.

Original languageEnglish (US)
Pages (from-to)401-404
Number of pages4
JournalJournal of Invasive Cardiology
Volume27
Issue number9
StatePublished - Sep 1 2015

Keywords

  • left main PCI
  • left main bifurcation
  • left main stenting

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