ORIGINAL RESEARCH article
Front. Cardiovasc. Med.
Sec. Coronary Artery Disease
Association between Plaque Characteristics and Side-branch Compromise in Left Main Bifurcation Lesions after a Single-stent Crossover Technique: Insights from an Optical Coherence Tomography Study
Jincheng Han
Huai Yu
Maoen Xu
Tao Chen
Chao Fang
Xingtao Huang
Jinfeng Tan
Lijia Ma
Huimin Liu
Zhuozhong Wang
Yanchao, Liu
GUO WEI
Haibo Jia
Bo Yu
The Second Affiliated Hospital of Harbin Medical University, Harbin, China
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Abstract
Background: The primary mechanism underlying side branch (SB) ostial compromise following main vessel (MV) stenting is the MV carina shift. However, the association between plaque characteristics or distribution and SB compromise remains unclear in patients with left main (LM) bifurcation lesions. Methods: A total of 123 patients with LM bifurcation lesions were included in the final analysis. Preprocedural optical coherence tomography (OCT) assessment of the LM-to-left anterior descending artery (LAD) segment was performed, and patients were treated with a single-stent crossover technique. Quantitative coronary angiography was performed to evaluate LM, LAD, and proximal left circumflex artery (LCX). Left circumflex artery ostium (LCX-OS) compromise was defined as residual stenosis > 50% after MV stenting. Results: LCX-OS compromise was observed in 33 patients in this study. Compared to the no compromise LCX-OS group, the compromise group had a higher frequency of plaque distribution in the LAD (90.9% versus 65.6%, p < 0.001), more prominent calcified plaque characteristics (60.6% versus 24.4%, p < 0.001), and a smaller LAD-LCX angle (81.2 ± 20.1 versus 98.0 ± 25.7, p = 0.001). Adjusted multivariate logistic regression analysis revealed that plaques distributed in the proximal LAD (OR, 6.119; p = 0.011), calcified plaque (OR, 6.511; p = 0.001), and the LAD-LCX angle (OR, 0.966; p = 0.003) were independent predictors of LCX-OS compromise. Conclusions: Plaque in the proximal LAD, presence of calcified plaque, and a smaller LAD-LCX angle may contribute to LCX-OS compromise following MV stenting in patients with LM bifurcation lesions. OCT has emerged as a promising tool for preprocedural risk stratification in LM bifurcation percutaneous coronary intervention, helping to mitigate the risk of LCX-OS compromise.
Summary
Keywords
left circumflex ostium compromise, Left main bifurcation, Optical Coherence Tomography, Plaque characteristics, Single-stent
Received
04 December 2025
Accepted
29 January 2026
Copyright
© 2026 Han, Yu, Xu, Chen, Fang, Huang, Tan, Ma, Liu, Wang, Liu, WEI, Jia and Yu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Haibo Jia; Bo Yu
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