Evaluation of major coronary artery bifurcation angles by digital angiography

Coronary artery stenosis and related clinical events are the most important cause of mortality worldwide. Percutan stent placement is an important alternative treatment method to a by-pass treatment. In invasive technique, bifurcation lesions are an important problem. Evaluation of bifurcation angle is known to be effective in determining the treatment technique and success of the process. The aim of this study was to investigate the diversity and average values of bifurcation angles with large populations to help develop new methods. In Firat University Hospital Cardiology Polyclinic, a total of 1005 (504 female, 501 male) patients who complained chest pain and who underwent diagnostic coronary angiography were evaluated retrospectively. Cardiomyopathy, heart failure, left ventricular hypertrophy, dilatation, atrial fibrillation, valvular or congenital heart disease, active connective tissue disease, symptomatic arrhythmia and branch block, patients with chronic liver and chronic renal failure, and by-pass patients were excluded from the study. Bifurcation angles measured in all cases are as follows; from left anterior oblique (LAO) caudal position; between left main coronary artery (LMCA) and left anterior descending (LAD), between LMCA and circumflex (Cx) and between LAD and Cx. From the right anterior oblique (RAO) caudal position; between Cx and first obtuse marginal artery (OM1) and between Cx and second obtuse marginal artery (OM2). From RAO cranial position; between LAD and diagonal arteries (D1 and D2). From LAO cranial position; between right coronary artery (RCA) and right ventriculus branch (RVD), between RCA and right marginal artery (RMD), and between posterior interventricular artery (PDA) and right posterolateral branch (PL). There were statistically significant differences between male and female cases in bifurcation angles. These measurements were grouped according to stent techniques. The bifurcation angles between LMCA-LAD, LMCA-Cx and LAD-Cx branches were found to be high (> 90 wide angle bifurcation) in male and female subjects. The bifurcation angles between the branches of Cx-OM1, Cx-OM2, LAD-D1, LAD-D2, RCA-RMD and PDA-PL were found to be high (<70 Y type bifurcation angle) in female and male subjects. The bifurcation angle between RCA-RVD branches was found in female subjects as follows; In 14 (2.8%) subjects '<70 Y type bifurcation' was found, in 209 (% 41.5) subjects '> 70-90 T type bifurcation' was found, in 281 (55.8%) subjects '> 90 wide angle bifurcation' was found. Male subject's results were found compatible with this. The correlations of all angles were examined. In the angular measurements between the main branches and the side branches (Cx-OM1, Cx-OM2, LAD-D1 and LAD-D2), very strong positive correlations (p <0.001) were found. When the correlations between RCA and its branches were examined, it was seen that there was a very strong positive correlation (p<0.001) amongst bifurcation angle measurements between the RCA-RMD branch and the PDA-PL branch. With the help of developing technology we believe that all these coronary angiography's datas will shed light on bifurcation stent techniques which is an important alternative to bypass.