Usefulness of longitudinal reconstructed optical coherence tomography images for predicting the need for the reverse wire technique during coronary bifurcation interventions.

Objectives The aim is to investigate the usefulness of longitudinal reconstructed optical coherence tomography (OCT) images in selecting the reverse wire (RW) technique for inserting a guidewire into a side branch (SB). Background It is sometimes necessary to protect the SB with a guidewire to prevent SB complications in PCI for bifurcation lesions. The RW is a novel method for guidewire insertion into an extremely angulated SB when the standard antegrade wire (AW) approach is difficult. Methods This retrospective study included 46 consecutive patients who underwent OCT-guided PCI in bifurcation lesions with significant SB stenosis. Patients were divided into two groups: 36 patients with successful guidewire crossing using the AW (AW group) and 10 patients with unsuccessful AW but successful RW guidewire crossing (RW group). SB angle and branch point (BP) slope, defined as the angle between the line connecting the proximal and distal BPs and the vertical, were measured using longitudinal reconstructed OCT images. Results The RW group had a significantly larger SB angle and higher BP slope than the AW group (108.7 +/- 11.4 degrees vs. 76.2 +/- 14.9 degrees; P < 0.0001, 128.7 +/- 31.6 degrees vs. 82.9 +/- 33.6 degrees; P = 0.0004, respectively). Receiver operating characteristic curve analysis indicated that SB angle >= 100 degrees and BP slope >= 120 degrees are optimal cutoff values for predicting the need for RW (area under the curve 0.97, sensitivity 90.0%, specificity 91.7%; area under the curve 0.83, sensitivity 80.0%, specificity 86.1%, respectively). Conclusions Longitudinal reconstructed OCT is useful for selecting the wiring technique for bifurcation lesions.