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Narrow B-angle is a predictor of SB closure


European Bifurcation Club 2015 – EBC 2015 – Athens, Greece

Technique specific problem solving

Narrow B-angle is a predictor of SB closure

Author: Robert J. Gil, MD, PhD, Mossakowski Medical Research Centre, Polish Academy of Sciences, Invasive Cardiology Dept., Central Hospital of the Internal Affairs, Ministry, Warsaw, Poland



  • The narrower angle alpha – angle between proximal MV and SB, the larger SB ostial stenosis after stent placement
  • Reasons for this SB compromise are carina displacement, SB ostium lateral stretching and change in ostial shape from circular to elliptic (Vassilev & Gil 2008, Yang 2015)
  • Extent of carina displacement and side branch ostial narrowing aler stenting depends on genetically determined length of the carina, plaque volume and distribution at SB ostium (SB ostial stenosis before stenting) – plaque shil (more correctly – SB ostial circular plaque redistribution) occurs in about 40% of cases
  • While carina displacement is a leading deformation for SB ostial stenosis at narrow B angle, lateral SB stretching plays major role at larger angulations (larger B angles) for SB ostial narrowing
  • The static factor (stent strut area and shape at SB ostium) will be more important with small SBs (size <2mm diameter) as stent area became larger relative SB ostial area
  • The EXACT MECHANISM of SB CLOSURE is practically UNKNOWN. It is possible it is combination of ostial stenosis increase, ostial obstruction from stent struts, ostial dissection, local thrombosis and vessel spasm. The last is highly possible as 70% of all occluded acutely SBs reopen at FU.


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