经皮冠状动脉介入治疗中单支架对吻技术后边支血管并发症的术前血管造影和血管内超声预测因素。
Preintervention angiographic and intravascular ultrasound predictors for side branch compromise after a single-stent crossover technique.
机构信息
Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
出版信息
Am J Cardiol. 2011 Jun 15;107(12):1787-93. doi: 10.1016/j.amjcard.2011.02.323. Epub 2011 Apr 18.
A single stent crossover technique is the most common approach to treating bifurcation lesions. In 90 bifurcation lesions with side branch (SB) angiographic diameter stenosis <75%, we assessed preintervention intravascular ultrasound (IVUS; of main branch [MB] and SB) predictors for SB compromise (fractional flow reserve [FFR] <0.80) after a single stent crossover. Minimal lumen area (MLA) was measured within each of 4 segments (MB just distal to the carina, polygon of confluence, MB just proximal to polygon of confluence, and SB ostium). All lesions showed Thrombolysis In Myocardial Infarction grade 3 flow in the SB after MB stenting. Although angiographic diameter stenosis at the SB ostium increased from 26 ± 15% before the procedure to 36 ± 21% after stenting (p = 0.001), FFR <0.80 was observed in only 16 patients (18%). Negative remodeling (remodeling index <1) was seen in 83 (92%) lesions but did not correlate with FFR after stenting. Independent predictors for FFR after stenting were maximal balloon pressure (p = 0.002) and MLA of SB ostium before percutaneous coronary intervention (p <0.001), MLA within the MB just distal to the carina (p = 0.025), and plaque burden at the SB ostium before percutaneous coronary intervention (p = 0.005), but not angiographic poststenting diameter stenosis or minimal lumen diameter. For prediction of FFR <0.80 after percutaneous coronary intervention, the best cutoff of MLA within the SB ostium before percutaneous coronary intervention was 2.4 mm(2) (sensitivity 94%, specificity 69%). Also, the cutoff of plaque burden within the SB ostium before percutaneous coronary intervention was ≥51% (sensitivity 75%, specificity 71%). In 67 lesions with an MLA ≥2.4 mm(2) or plaque burden <50% before percutaneous coronary intervention, 63 (94%) showed FFR ≥0.80. However, FFR <0.80 was seen in only 12 (52%) of 23 lesions with an MLA <2.4 mm(2) and plaque burden ≥50%. In conclusion, there do not appear to be reliable IVUS predictors of functional SB compromise after crossover stenting.
单支架对吻技术是治疗分叉病变最常用的方法。在 90 例分叉病变患者中，侧支（SB）的血管造影狭窄率<75%，我们评估了单支架对吻技术后 SB 狭窄（血流储备分数[FFR] <0.80）的术前血管内超声（IVUS；主支[MB]和 SB）预测因子。在 MB 支架置入术前后，对 4 个节段（MB 在嵴部远端、汇合处多边形、MB 在汇合处近端和 SB 开口）内的每个节段进行最小管腔面积（MLA）测量。所有病变在 MB 支架置入后 SB 内均显示心肌梗死溶栓治疗（TIMI）血流 3 级。尽管 SB 开口处的血管造影狭窄程度从术前的 26±15%增加到支架置入后的 36±21%（p=0.001），但仅 16 例（18%）患者出现 FFR <0.80。83 例（92%）病变出现负性重构（重构指数<1），但与支架置入后的 FFR 无关。支架置入后 FFR 的独立预测因子是最大球囊压力（p=0.002）和 SB 开口处的 SB 置入前 MLA（p<0.001）、MB 在嵴部远端的 MLA（p=0.025）和 SB 开口处的斑块负荷（p=0.005），但与支架置入后的血管造影狭窄程度或最小管腔直径无关。对于预测 SB 介入治疗后 FFR <0.80，SB 开口处 SB 介入治疗前 MLA 的最佳截断值为 2.4mm²（敏感性 94%，特异性 69%）。此外，SB 开口处 SB 介入治疗前斑块负荷的截断值≥51%（敏感性 75%，特异性 71%）。在 67 例 SB 介入治疗前 MLA≥2.4mm²或斑块负荷<50%的病变中，63 例（94%）FFR≥0.80。然而，在 23 例 MLA<2.4mm²和斑块负荷≥50%的病变中，仅 12 例（52%）出现 FFR<0.80。总之，在交叉支架置入后，似乎没有可靠的 IVUS 预测功能性 SB 狭窄的指标。
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