Kuroda N, Kobayashi Y, Yamamoto Y, Komiyama N, Masuda Y
The Third Department of Internal Medicine, Chiba University, Japan.
Jpn Circ J. 2000 Nov;64(11):883-5. doi: 10.1253/jcj.64.883.
After placing a stent in the main vessel of a bifurcation lesion, it is sometimes necessary to perform further balloon inflation in order to treat an ostial lesion in a side branch. The stent struts may prevent full balloon expansion at the ostium of a side branch, resulting in residual ostial stenosis. The degree of completeness of balloon inflation may vary significantly depending on the stent design and structure. A model of a bifurcation lesion with an angle of 45 degrees was created from acrylic resin. The diameters of the main vessel and the side branch were both 3.5 mm. Deployment of the Palmaz-Schatz stent (n=5), NIR stent (n=5) or Multi-Link stent (n=5) was performed in the main vessel with a 3.5-mm balloon catheter inflated to 12 atm. A 3.5-mm balloon catheter was then inflated to 12 atm through the stent struts of the main vessel and into the ostium of the side branch. The degree of completeness of balloon inflation (% balloon expansion) was calculated as (smallest diameter of balloon catheter/reference diameter of balloon catheter) x 100%. The minimal lumen diameter (MLD) and cross-sectional area (CSA) at the ostium of the side branch created with the stent struts were also measured. Limited balloon expansion through the struts was observed with the Palmaz-Schatz stent and the NIR stent, but almost full balloon expansion was observed with the Multi-Link stent (% balloon expansion: Palmaz-Schatz stent 80%, NIR stent 60%, Multi-Link stent 94%, p<0.01). The MLD and CSA of the dilated struts, representing the ostium of the side branch, of the Palmaz-Schatz stent (2.2+/-0.1 mm, 4.5+/-0.3 mm2) and the NIR stent (1.8+/-0.1 mm, 3.1+/-0.3 mm2) were significantly smaller compared with those of the Multi-Link stent (3.0+/-0.2 mm, 8.4+/-0.6 mm2) (p<0.01). The struts of the Palmaz-Schatz stent and the NIR stent deployed in the main vessel of a bifurcation prevent full expansion of a balloon catheter inflated at the side branch ostium. In contrast, almost full balloon expansion through the struts of the Multi-Link stent is achieved.
在分叉病变的主血管中置入支架后，有时需要进一步进行球囊扩张，以治疗分支血管的开口病变。支架小梁可能会阻止球囊在分支血管开口处完全扩张，从而导致残余开口狭窄。球囊扩张的完全程度可能会因支架设计和结构的不同而有显著差异。用丙烯酸树脂制作了一个角度为45度的分叉病变模型。主血管和分支血管的直径均为3.5毫米。使用3.5毫米球囊导管在主血管中以12个大气压充气，置入5枚帕尔马兹-沙茨（Palmaz-Schatz）支架、5枚近红外（NIR）支架或5枚多链接（Multi-Link）支架。然后，通过主血管的支架小梁将3.5毫米球囊导管充气至12个大气压，并进入分支血管的开口处。球囊扩张的完全程度（%球囊扩张）计算为（球囊导管最小直径/球囊导管参考直径）×100%。还测量了由支架小梁形成的分支血管开口处的最小管腔直径（MLD）和横截面积（CSA）。使用帕尔马兹-沙茨支架和近红外支架时，观察到通过小梁的球囊扩张受限，但使用多链接支架时观察到几乎完全的球囊扩张（%球囊扩张：帕尔马兹-沙茨支架80%，近红外支架60%，多链接支架94%，p<0.01）。与多链接支架（3.0±0.2毫米，8.4±0.6平方毫米）相比，帕尔马兹-沙茨支架（2.2±0.1毫米，4.5±0.3平方毫米）和近红外支架（1.8±0.1毫米，3.1±0.3平方毫米）的扩张小梁所代表的分支血管开口处的MLD和CSA明显更小（p<0.01）。置入分叉病变主血管中的帕尔马兹-沙茨支架和近红外支架的小梁会阻止在分支血管开口处充气的球囊导管完全扩张。相比之下，使用多链接支架的小梁可实现几乎完全的球囊扩张。
