Kefei Dou
Fuwai Hospital, China Managing left main bifurcation lesions has always been one of the most complex challenges in interventional cardiology. These lesions, which account for 5-7% of coronary cases and often involve the distal bifurcation, are associated with high mortality rates. Despite significant advances in treatment strategies, predicting and preventing side branch (SB) occlusion during left main (LM) percutaneous coronary intervention (PCI) remains a pivotal goal.

The LM V-RESOLVE score is a new, angiographic-based scoring system developed to predict the risk of SB occlusion in LM bifurcation PCI. It builds on previous versions of the RESOLVE score series, which have been widely recognized for their utility in assessing bifurcation lesion risk. However, the earlier RESOLVE models were limited in their application to LM bifurcations, as less than 5% of the initial development cohorts included these lesion types. The LM V-RESOLVE score was specifically designed to address these gaps, incorporating anatomical differences unique to LM bifurcations.

The study behind the LM V-RESOLVE score analyzed a cohort of 855 patients who underwent LM bifurcation PCI with a provisional stenting strategy. After extensive data collection and regression modeling, three key angiographic parameters were identified as predictors of SB occlusion: main vessel (MV) plaque distribution, MV/SB diameter ratio, and SB baseline stenosis. Each factor contributes to the score, with higher values reflecting greater risk. For example, a stenosis rate of 70-90% in the SB adds three points to the score, while a stenosis greater than 90% adds seven points.

The LM V-RESOLVE score was validated both internally and externally, showing excellent predictive accuracy with a C-statistic of 0.83. It successfully stratifies lesions into low-risk (score <8) and high-risk (score ≥8) categories. Patients in the high-risk group experienced significantly higher rates of SB occlusion (7.4%) and single-stent failure (16.7%) compared to those in the low-risk group, where these rates were just 0.6% and 3.7%, respectively.

This scoring system is not only accurate but also practical. By relying on visual angiographic estimation, the LM V-RESOLVE score provides a rapid and accessible method for risk assessment, even in settings where advanced imaging modalities like intravascular ultrasound (IVUS) may not be feasible. While IVUS remains a gold standard, its use can be limited by patient factors, lesion complexity, and additional procedural costs. The LM V-RESOLVE score serves as a valuable complementary tool, especially in resource-constrained environments.
By integrating the LM V-RESOLVE score into routine decision-making, interventional cardiologists can better anticipate complications, tailor their stenting strategies, and ultimately improve outcomes for patients with LM bifurcation lesions.

This innovative tool represents a step forward in precision medicine, bridging the gap between complex imaging techniques and everyday clinical application. The LM V-RESOLVE score reaffirms the importance of meticulous pre-procedural planning and highlights the power of simple yet effective risk assessment tools in left main bifurcation PCI.

Live Case 2: Left Main & Bifurcation

Friday, November 29, 10:50 AM ~ 12:40 PM
Main Arena

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