Though a wide degree of divergence is exhibited by the functional significance, predictors, and luminal changes of compromised side-branch ostium after the main vessel (MV) stenting, the treatment of choice for left main (LM) bifurcation lesions is preferably the single-stent approach. After LM to left anterior descending (LAD) artery stenting, a compromised LCx may be due to carina shift or plaque. To improve the clinical outcomes, fractional flow reserve (FFR)-guided LCx interventions have been proposed. 


The possible treatment strategies for compromised LCx were intended to be established by the study. The predictors for low FFR at LCx were also aimed to be determined.


Between February 2015 and November 2020, a retrospective, single-center study was organized at the Department of Cardiology, First Affiliated Hospital of Xian Jiaotong University, PR China. The study included 563 patients whose angiographic diameter stenosis (DS > 50%) after MV stenting indicated a possibly significant or significant ostial LCx lesion. Interventions were considered in 116 (20.6%) patients with FFR < 0.8. According to the operator's preference, three interventional techniques were used:

  • Conversion to the two-stent technique

  • Drug-eluting balloon (DEB)

  • Kissing balloon inflation (KBI)

Major adverse cardiac events (MACE), comprising stent thrombosis, revascularizations, MI, cardiac and non-cardiac deaths, were noted among the patients for a mean of 32.2 ± 8.9 months.


FFR < 0.8 was observed post-LM stenting in only 116 (20.6%) patients.

Between the high (16.8%) and low (15.5% p = 0.744) FFR groups, composite MACE rates were comparable at three years.

Multivariate analysis of low FFR at the LCx:

  • Post-stenting LCx plaque burden Odds ratio (OR) 1.166, p < .001

  • Post-stenting minimal luminal area (MLA) of LCx OR: 0.032, p < .001

  • Pre-stenting LCx MLA OR: 0.371, p = .044

  • Post-stenting LM MLA OR: 0.821, p = .038

Three-year MACE rates in the low-FFR group:

  • Stenting: 20.5%

  • KBI: 17.5%

  • DEB: 8.1%

The lowest three-year MACE rate was noted in deb managed compromised LCx patients.


FFR-guided LCx intervention can aid in preventing LCx interventions which are unnecessary. IVUS guided predictors of low FFR post-stenting are plaque burden of the LCx, post-stenting MLA, and main vessel stent length.


Disease Condition,Therapeutic Modality,Coronary Artery Disease,Interventional Cardiology,DCAD_others,Percutaneous Coronary Intervention