Percutaneous interventions in unprotected left main lesions: Novel three-dimensional imaging and quantitative analysis before and after intervention

Objective: To examine the potential yield of three-dimensional (3D) reconstruction of left main coronary lesions. Methods: A novel, previously validated, system for 3D reconstruction of the coronary vessels was used to evaluate 302 angiographic images, before and after stenting, from 62 consecutive patients (age 73.5±11.3 years) with unprotected left main lesions. Results: Three-dimensional reconstructions significantly improved morphological analysis, especially for ostial and bifurcation lesions. In cases of bifurcation involvement, lesion length was significantly longer in the 3D reconstructions than in the 2D images (12.3±4.1 vs. 10.6±4.9 mm, P=003). The 3D analysis showed that procedures performed in distal left main were associated with a decrease in the bifurcation angle after intervention (from 82±27° to 72±28°, P=01). The mortality rate was 18% at 6 months. Elective intervention was associated with significantly lower mortality (5% vs. 39% at 6 months). Conclusions: Three-dimensional reconstruction adds insights on the morphology and lesion length of unprotected left main artery lesions, especially those involving the bifurcation, which may make it an important tool in planning interventional procedures and evaluating their results.