Scottsdale Heart Group, Scottsdale Healthcare Hospitals, Scottsdale, Arizona 85258, USA.
J Interv Cardiol. 2009 Dec;22(6):537-46. doi: 10.1111/j.1540-8183.2009.00509.x. Epub 2009 Nov 13.
Provisional T-stenting is a widely used strategy for the treatment of coronary artery bifurcation lesions. However, the use of conventional stents in this setting is limited by multiple factors; this includes technical considerations such as wire wrap when accessing the involved vessel, and stent overlap at or near the carina of the lesion. In addition, current slotted tube stent technology tends to be associated with gaps in the coverage of the side branch ostium, which may result in restenosis in that segment of the lesion. The Pathfinder device, now more commonly referred to as the Xience Side Branch Access System (Xience SBA) is a drug-eluting stent (DES) designed specifically to assist in the treatment of bifurcation lesions by allowing wire access into the side branch, irrespective of the treatment strategy to be employed.
The Xience SBA drug-eluting stent was compared with the standard Vision coronary stent system using a provisional T-stenting strategy in a perfused synthetic model of the coronary vasculature with side branch angulations of 30 degrees , 50 degrees , 70 degrees , and 90 degrees . Stent delivery was performed under fluoroscopic guidance. Following the procedure, high-resolution 2D Faxitron imaging was used to evaluate deployment accuracy of the side branch stent relative to the main branch stent.
Deployment of the Xience SBA was accomplished in the same total time as the standard stents in a provisional T-stenting approach (14.9 vs. 14.6 minutes). However, the time required to achieve stent deployment in the main branch was less with the Xience SBA (4.0 vs. 6.6 minutes), and as a result, total contrast usage (49.4 vs. 69.4 cm(3)) and fluoroscopy time (5.1 vs. 6.2 minutes) was lower. Additionally, the Xience SBA had a lower incidence of wire wrap (22% vs. 89%) and less distal protrusion of the side branch stent into the main branch (0.54 vs. 1.21 mm). Significant gaps in ostial side branch coverage were not seen in either group.
The Xience Side Branch Access DES is a viable device for consistently accessing coronary bifurcation lesions; it allows for easy wire access into the side branch. This may assist the operator in overcoming those well-recognized limitations associated with use of standard one- or two-stent strategies. In this perfused synthetic coronary model, Xience SBA deployment required less contrast usage and shorter fluoroscopy times. Further testing of this device is warranted.
临时 T 型支架术是一种广泛应用于治疗冠状动脉分叉病变的策略。然而，在这种情况下使用传统支架受到多种因素的限制；其中包括进入受累血管时的导丝缠绕等技术因素，以及支架在病变的嵴部附近或处的重叠。此外，目前的开槽管支架技术往往与侧支开口的覆盖间隙相关，这可能导致病变该段再狭窄。Pathfinder 装置，现在更通常称为 Xience 侧支接入系统（Xience SBA），是一种药物洗脱支架（DES），专门设计用于通过允许导丝进入侧支，来辅助治疗分叉病变，而不论采用何种治疗策略。
在具有 30 度、50 度、70 度和 90 度侧支成角的冠状动脉血管灌注模拟模型中，使用临时 T 型支架术策略，将 Xience SBA 药物洗脱支架与标准 Vision 冠状动脉支架系统进行比较。支架输送在荧光透视引导下进行。手术后，使用高分辨率 2D Faxitron 成像来评估侧支支架相对于主支支架的部署准确性。
在临时 T 型支架术方法中，Xience SBA 的部署总时间与标准支架相同（14.9 分钟 vs. 14.6 分钟）。然而，Xience SBA 实现主支支架部署所需的时间更短（4.0 分钟 vs. 6.6 分钟），因此，总造影剂用量（49.4 立方厘米 vs. 69.4 立方厘米）和荧光透视时间（5.1 分钟 vs. 6.2 分钟）也更低。此外，Xience SBA 的导丝缠绕发生率较低（22% vs. 89%），侧支支架向主支突出的程度较低（0.54 毫米 vs. 1.21 毫米）。两组均未观察到侧支开口覆盖的明显间隙。
Xience 侧支接入 DES 是一种可行的装置，可用于稳定地进入冠状动脉分叉病变；它允许轻松将导丝进入侧支。这可能有助于操作者克服与使用标准的单支架或双支架策略相关的那些公认的局限性。在这个灌注的合成冠状动脉模型中，Xience SBA 的部署需要更少的造影剂用量和更短的荧光透视时间。需要进一步测试该设备。
