Bifurcation angle in bifurcation stenting is widely debated subject there seems wide disparity among different trials some saying there is no impact of by bifurcation angle while some say distal bifurcation angle wider is bad while others say narrow is bad.
Recently bifurcation club meeting minuets published in eurointervention suggested that distal bifurcation angle impact on outcome is still a controversy, still there is need for further study. Stenting strategy is to be modified by bifurcation angle.
|Medina bifurcation lesion classification
Bifurcation lesion is classified most commonly by medina. See diagram below. Angles are named as follows. Angle “A” for angle between main vessel and side branch. Angle “B” is between two distal branches. Angle “C” for angle between main branch and main vessel.
Decrease in bifurcation angle following stenting has bad prognosis click here this most commonly occurs following two stent strategy i.e. Crush technique.
Lumen loss at ostium of LCX occurred in narrow distal angle between LAD and LCX, this was shown by Kang et al, mechanism was mainly carina shift.
Asian Multicentre DES-LMCA registry showed that narrow distal angle had lower cardiac events compared higher distal bifurcation angle at five year follow-up.
A sub study of Syntex trial by Girasisand colleagues showed no impact of bifurcation angle on outcome after stenting.
Chen et al showed when Crush technique is used bifurcation angle has no impact on outcome. But Dzavik et al had different result for crush technique i.e. if bifurcation angle is more than 50 degree than MACE was more
Final kissing balloon inflation (FKBI ) and bifurcation angle ,Chen et al found decreased MACE with higher bifurcation angle with FKBI than those without FKBI.