Kinoshita Yoshihisa, Kashima Yoshifumi, Suzuki Takahiko
Toyohashi Heart Center, Aichi, Japan.
J Invasive Cardiol. 2006 Sep;18(9):428-31.
In the drug-eluting stent era, minimum stent diameter is one independent predictor of restenosis. Some plaque modification is necessary before stenting to obtain the minimum stent diameter, but plaque modification using current devices is difficult in certain lesions, such as those in eccentric small vessels. As a potential solution to this problem, we investigate the usefulness of a single-blade Cutting Balloon (SCB) in this study.
We used the SCB in 5 porcine coronary arteries (2 LAD, 1 LCx and 2 RCA) to investigate the feasibility of directional atherotomy. We also tried the kissing balloon technique (KBT) with the SCB in 3 bifurcations from the same arteries. We used intravascular ultrasound (IVUS) guidance to position and direct the atherotome using the side holes of the guiding catheter as a marker. We also assessed plaque modification with IVUS before and after percutaneous coronary intervention and took coronary sections to inspect tissue pathology after the procedures.
In all 5 porcine models, we were able to view and confirm the success and accuracy of our incision on IVUS. We were successfully able to control the direction of the blade without balloon rupture during KBT. We were also able to verify the directional incisions afterwards from examination of tissue pathology.
Our investigation suggests that this SCB may be used effectively for directional atherotomy. We can accurately modify the plaque with this device by correctly positioning the blade to choose the direction of the incision. The next challenge is to improve the reliability of the device and to move on to in vivo trials.
在药物洗脱支架时代，最小支架直径是再狭窄的一个独立预测因素。在置入支架前进行一些斑块修饰以获得最小支架直径是必要的，但使用现有器械在某些病变中，如偏心小血管病变中进行斑块修饰很困难。作为解决这一问题的潜在方案，我们在本研究中探讨了单刃切割球囊（SCB）的有效性。
我们在5头猪的冠状动脉（2支左前降支、1支左旋支和2支右冠状动脉）中使用SCB，以研究定向斑块切除术的可行性。我们还在同一动脉的3处分叉处对SCB尝试了双球囊对吻技术（KBT）。我们使用血管内超声（IVUS）引导，以引导导管的侧孔作为标记来定位和引导斑块切除刀。我们还在经皮冠状动脉介入治疗前后用IVUS评估斑块修饰情况，并在术后取冠状动脉切片检查组织病理学。
在所有5头猪模型中，我们能够在IVUS上观察并确认切口的成功与准确性。在KBT过程中，我们成功地控制了刀片方向且球囊未破裂。我们还能够通过组织病理学检查验证术后的定向切口。
我们的研究表明，这种SCB可有效地用于定向斑块切除术。通过正确定位刀片以选择切口方向，我们可以用该器械准确地修饰斑块。下一个挑战是提高该器械的可靠性并开展体内试验。
