Wang, Zhiqing (56415976400)Zhiqing (56415976400)WangYang, Junqing (54792452400)Junqing (54792452400)YangLi, Chunming (57222227112)Chunming (57222227112)LiHuang, Jiayue (57201477168)Jiayue (57201477168)HuangFezzi, Simone (57218421704)Simone (57218421704)FezziChen, En (57208253773)En (57208253773)ChenCai, Wei (42661093300)Wei (42661093300)CaiStankovic, Goran (59150945500)Goran (59150945500)StankovicWijns, William (7006420435)William (7006420435)WijnsChen, Lianglong (26663007800)Lianglong (26663007800)ChenTu, Shengxian (24479856500)Shengxian (24479856500)Tu2025-06-122025-06-122023https://doi.org/10.1016/j.ijcard.2023.02.030https://www.scopus.com/inward/record.uri?eid=2-s2.0-85148850834&doi=10.1016%2fj.ijcard.2023.02.030&partnerID=40&md5=e634b570c88d70da7f9c2ce0ed5db75dhttps://remedy.med.bg.ac.rs/handle/123456789/2724Background: Two-stent techniques for percutaneous coronary intervention (PCI) on left main (LM) bifurcation (LMB) lesions are associated with an increased risk of in-stent restenosis (ISR) at left circumflex artery (LCx) ostium but the underlying mechanisms are incompletely understood. This study sought to investigate the association between cyclic change of LM-LCx bending angle (BALM-LCx) and the risk of ostial LCx ISR following two-stent techniques. Methods: In a retrospective cohort of patients undergoing two-stent PCI for LMB lesions, BALM-LCx and distal bifurcation angle (DBA) were computed with 3-dimensional angiographic reconstruction. The analysis was performed both at end-diastole and end-systole, and the angulation change throughout the cardiac cycle was defined as the cardiac motion-induced angulation change (∆CAngle). Results: A total of 101 patients were included. The mean pre-procedural BALM-LCx was 66.8 ± 16.1° at end-diastole and 54.1 ± 13.3° at end-systole with a range of 13.0 ± 7.7°. Pre-procedural ∆CBALM-LCx > 16.4° was the most relevant predictor of ostial LCx ISR (adjusted OR 11.58, 95% CI 4.04–33.19; p < 0.001). Post-procedural ∆CBALM-LCx > 9.8° and stent-induced diastolic BALM-LCx change > 11.6° were also related with ostial LCx ISR. DBA was positively correlated with BALM-LCx and showed a weaker association of pre-procedural ∆CDBA > 14.5° with ostial LCx ISR (adjusted OR 6.87, 95% CI 2.57–18.37; p < 0.001). Conclusions: Three-dimensional angiographic bending angle is a feasible and reproducible novel method for LMB angulation measurement. A large pre-procedural cyclic change of BALM-LCx was associated with an increased risk of ostial LCx ISR following two-stent techniques. © 2023 Elsevier B.V.Cardiac motion-induced angle changeDistal bifurcation angleIn-stent restenosisLeft main bifurcation lesionLeft main-left circumflex bending angle