Intravascular ultrasound has been suggested to optimize stent diameter and length in Left Main (LM) procedures, but in the real-world ostial LM stenting is often accomplished with angiography only guidance. The Finet law which regulates the fractal geometry of human bifurcation has the potential to increase the accuracy of stent-sizing. To retrospectively evaluating the impact on outcomes of the addition of Finet Law to standard quantitative coronary angiography (QCA) in guiding stent selection of ostial LM stenting compared to standard angiography estimation.
We retrospectively evaluated the clinical and instrumental records of patients with isolated ostial LM disease and bypass surgery contraindications or refusal as determined by the local Heart Team who received stenting from 1 January 2012 to 1 January 2017 at Rovigo General Hospital. Patients were discrimined on the basis of the addition to QCA angiographic evaluation of the Finet–law.
Seventy-three patients (45 males, mean age 69.9 ± 10.9 years old) ostial LM stenting, 36 patients using QCA and Finet law (QCA-Finet) and 37 using standard QCA angiographic (QCA-angio) evaluation of the vessel diameter. By QCA, vessel size, mean stent diameter at implantation and after post-dilatation were clearly bigger in the QCA+ Finet than QCA-angio (4.4 ± 0.8 and 3.8 ± 0.7, p < 0.001). At a mean follow-up of 5.0 ± 0.4 years, cardiovascular mortality and cardiovascular events incidence were higher in QCA-angio compared to QCA+Finet group of patients.
Our study suggested that adding the Finet law to standard angiography estimation of the LM stent size may improve long-term outcomes.
- Intravascular ultrasound has been suggested to optimize left main stenting.
- Finet law allows for calculating the main vessel diameter in a pohisiologically accurate way.
- LM stenting by angiographic QCA vessel diameter estimation had worse long-term outcomes compared patients in whom the Finet law has been used.
Cardiovascular Revascularization Medicine, 2018-10-01, Volume 19, Issue 7, Pages 751-754, Copyright © 2018 Elsevier Inc.