Jim Man-Hong, Ho Hee-Hwa, Miu Raymond, Chow Wing-Hing
Cardiac Medical Unit, Grantham Hospital, Hong Kong, China.
Catheter Cardiovasc Interv. 2006 Mar;67(3):403-9. doi: 10.1002/ccd.20645.
We report a modified crush technique with double kissing balloon inflation (the sleeve technique) in an attempt to increase the success rate of final kissing balloon inflation, which has been shown to improve the angiographic outcomes of side branch in bifurcation lesions. A stent was advanced across the side branch with protrusion of 3-5 mm of proximal stent segment into the main vessel. At the same time, a size-matched balloon with length long enough to cover the bifurcation as well as the protruding stent segment was placed in the main vessel. The side-branch stent is deployed first, the wire and stent balloon are removed. This is followed by balloon inflation in main vessel at high pressure to crush the protruding stent segment against vessel wall. The side branch is then rewired, two balloons are advanced to the main vessel and side branch, and the bifurcation is kissed with balloons the first time. The side branch is now like a new sleeve. The balloon and wire of the side branch are removed. Another stent was positioned and then deployed in the main vessel. The side branch is rewired the second time, two balloons are advanced to the main vessel and side branch again, followed by final (second) kissing balloon inflation of the bifurcation. The sleeve technique has been employed in six consecutive patients with 100% success rate of final kissing balloon inflation. There was no major adverse cardiac events or stent thrombosis encountered within 30 days of percutaneous coronary intervention.
我们报告了一种改良的挤压技术，即双球囊对吻扩张（套管技术），旨在提高最终球囊对吻扩张的成功率，这已被证明可改善分叉病变中分支血管的血管造影结果。将一枚支架穿过分支血管，使近端支架节段在主血管中突出3 - 5毫米。与此同时，将一个尺寸匹配、长度足以覆盖分叉及突出支架节段的球囊置于主血管中。首先植入分支血管支架，然后撤出导丝和支架球囊。接着在主血管中高压充盈球囊，将突出的支架节段挤压至血管壁。随后重新在分支血管中置入导丝，将两个球囊分别推进至主血管和分支血管，首次对分叉处进行球囊对吻扩张。此时分支血管就像一个新的套管。撤出分支血管的球囊和导丝。再在主血管中定位并植入另一枚支架。再次在分支血管中置入导丝，将两个球囊再次分别推进至主血管和分支血管，随后对分叉处进行最终（第二次）球囊对吻扩张。该套管技术已连续应用于6例患者，最终球囊对吻扩张成功率达100%。在经皮冠状动脉介入治疗后30天内未发生主要不良心脏事件或支架血栓形成。
