Collins Nicholas, Dzavik Vladimir
Interventional Cardiology Program, Division of Cardiology, University Health Network, Toronto, Ontario, Canada.
Catheter Cardiovasc Interv. 2006 Sep;68(3):365-71. doi: 10.1002/ccd.20791.
Despite the advent of drug eluting stents and newer interventional techniques designed to treat the main vessel and side branch in bifurcation stenoses, optimal treatment of the side branch remains problematic. We aimed to assess the feasibility of a modified balloon crush technique for percutaneous treatment of coronary bifurcation stenoses.
Use of the crush technique in bifurcation stenoses remains limited by access to the side branch after main vessel stent deployment, as well as limitations of side branch stent deployment. The modified balloon crush technique aims to improve side branch access and stent apposition.
The modified balloon crush is similar to the previously described balloon crush technique. Following side branch stent deployment, a balloon positioned in the main vessel is deployed to crush the proximal side branch stent. A guide wire is then placed into the side branch with a subsequent high-pressure balloon inflation at the side branch ostium. This opens the stent struts at the ostium of the side branch, facilitating future passage of the guide wire following main vessel stent deployment, prior to kissing balloon inflation.
We performed this modification of the crush technique safely in 10 patients. We were successful in obtaining side branch access in nine of ten patients following initial main vessel stent deployment. In the only failure, there was a 90 degrees angle between the main vessel and side branch.
The modified balloon crush technique can be safely performed, while optimizing side branch access and side branch stent apposition.
尽管药物洗脱支架问世，且出现了旨在治疗分叉狭窄主血管和侧支的新型介入技术，但侧支的最佳治疗仍存在问题。我们旨在评估改良球囊挤压技术经皮治疗冠状动脉分叉狭窄的可行性。
在分叉狭窄中使用挤压技术仍受到主血管支架置入后侧支通路以及侧支支架置入限制的制约。改良球囊挤压技术旨在改善侧支通路和支架贴壁情况。
改良球囊挤压技术与先前描述的球囊挤压技术相似。在侧支支架置入后，将位于主血管内的球囊展开以挤压近端侧支支架。然后将导丝置入侧支，并随后在侧支开口处进行高压球囊扩张。这会打开侧支开口处的支架小梁，便于在主血管支架置入后、球囊对吻扩张前，导丝能在后续顺利通过。
我们在10例患者中安全地实施了这种挤压技术的改良。在最初的主血管支架置入后，10例患者中有9例成功获得侧支通路。唯一失败的病例中，主血管与侧支之间呈90度角。
改良球囊挤压技术可安全实施，同时优化侧支通路和侧支支架贴壁情况。
