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Bhaktha M.D. Maddhavapeddy Aditya M.D. Maddury Jyotsna M.D.

Importance Of Proximal Angle And Interpolated Minimal Luminal Diameter In Coronary Bifurcation Lesions. Nizam’s Institute of Medical Sciences Hyderabad, Andhra Pradesh, India. Bhaktha M.D. Maddhavapeddy Aditya M.D. Maddury Jyotsna M.D. INTRODUCTION.

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Bhaktha M.D. Maddhavapeddy Aditya M.D. Maddury Jyotsna M.D.

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  1. Importance Of Proximal Angle And Interpolated Minimal Luminal Diameter In Coronary Bifurcation Lesions Nizam’s Institute of Medical Sciences Hyderabad, Andhra Pradesh, India. Bhaktha M.D. Maddhavapeddy Aditya M.D. Maddury Jyotsna M.D.

  2. INTRODUCTION • Angioplasty of bifurcation lesions represents a continuing challenge. • Bifurcation interventions vs. Non-bifurcation interventions • Lower rate of procedural success • Higher procedural costs • Longer hospitalization • Higher rate of clinical and angiographic restenosis. • Side branch compromization. We require definitive predictors for side branch pinching for adaptation of better treatment strategy.

  3. AIM • We hypothesized proximal angle and interpolated minimal luminal diameter are additional important factors in predicting the pinching of side branch.

  4. METHODOLOGY • Bifurcation lesion was classified according to ICPS classification. • We calculated the • Diameter of vessels with percentage stenosis • Proximal main vessel • Distal main vessel • Side branch • Interpolated minimal luminal diameter • Bifurcation angle • BA- angle between distal main vessel and side branch • PA- angle angle between proximal main vessel and side branch.

  5. RESULTS • Analyzed 56 bifurcation lesions under went PCI. • Draw the diagram of bifurcation and label it.

  6. Table • Combine the reference vessel diameter and percetage stenosis and make a single table

  7. TABLE-1

  8. Icps classification • Different no. • Then pinching

  9. Draw a curve with side branch diameter on x axis and pa angle on y axis and ba angle on z axis.

  10. Pinching of the side branch occurred after stenting of main branch – already known conventional factors • Smaller the size of side branch diameter • disease in side branch • Type 1 bifurcation has more pinching after main vessel stenting followed by type 2

  11. Cont…. In general - pinching of the side branch occurred after stenting of main branch – proposed factors • PA angle is >130º • BA angle < 45º • interpolated minimal diameter is <1 mm • In patients with normal side branch - Pinching of side branch is not determinant by neither BA angle (59º vs. 60º) nor PA angle (with pinching 131º vs without pinching 127º) . • Effect of different angles on TIMI flows- PA angle is >130º then final TIMI 3 flow is good BA angle doesn’t determine the final TIMI flow

  12. CONCLUSIONS • It is important to observe PA angle and interpolated minimal luminal diameter along with bifurcation angle and disease in side branch to predict the compromization of side branch.

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