Visual estimation versus different quantitative coronary angiography methods to assess lesion severity in bifurcation lesions

Maik J. Grundeken, Carlos Collet, Yuki Ishibashi, Philippe Généreux, Takashi Muramatsu, Laura LaSalle, Aaron V. Kaplan, Joanna J. Wykrzykowska, Marie Angèle Morel, Jan G. Tijssen, Robbert J. de Winter, Yoshinobu Onuma, Martin B. Leon, Patrick W. Serruys

Research output: Contribution to journalArticlepeer-review

11 Citations (Scopus)


Objectives: To compare visual estimation with different quantitative coronary angiography (QCA) methods (single-vessel versus bifurcation software) to assess coronary bifurcation lesions. Background: QCA has been developed to overcome the limitations of visual estimation. Conventional QCA however, developed in “straight vessels,” has proved to be inaccurate in bifurcation lesions. Therefore, bifurcation QCA was developed. However, the impact of these different modalities on bifurcation lesion severity classification is yet unknown. Methods: From a randomized controlled trial investigating a novel bifurcation stent ( NCT01258972), patients with baseline assessment of lesion severity by means of visual estimation, single-vessel QCA, 2D bifurcation QCA and 3D bifurcation QCA were included. We included 113 bifurcations lesions in which all 5 modalities were assessed. The primary end-point was to evaluate how the different modalities affected the classification of bifurcation lesion severity and extent of disease. Results: On visual estimation, 100% of lesions had side-branch diameter stenosis (%DS) >50%, whereas in 83% with single-vessel QCA, 27% with 2D bifurcation QCA and 26% with 3D bifurcation QCA a side-branch %DS >50% was found (P < 0.0001). With regard to the percentage of “true” bifurcation lesions, there was a significant difference between visual estimate (100%), single-vessel QCA (75%) and bifurcation QCA (17% with 2D bifurcation software and 13% with 3D bifurcation software, P < 0.0001). Conclusions: Our study showed that bifurcation lesion complexity was significantly affected when more advanced bifurcation QCA software were used. “True” bifurcation lesion rate was 100% on visual estimation, but as low as 13% when analyzed with dedicated bifurcation QCA software.

Original languageEnglish
Pages (from-to)1263-1270
Number of pages8
JournalCatheterization and Cardiovascular Interventions
Issue number7
Publication statusPublished - 01-06-2018

All Science Journal Classification (ASJC) codes

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine


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