Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, United Kingdom.
EuroIntervention. 2012 Jun 20;8(2):205-13. doi: 10.4244/EIJV8I2A34.
The aim of this study was to assess the ability of optical coherence tomography (OCT) to guide recrossing during percutaneous coronary interventions in bifurcations and to reduce strut malapposition.
Fifty-two patients undergoing elective treatment of bifurcation lesions using provisional stenting as default strategy were included in the study. Patients were divided into two groups: OCT-guided stent recrossing (group 1, n=12), and angiography-guided recrossing (group 2, n=40). Malapposition in the various bifurcation segments was compared in the two groups, using propensity score analysis to correct for confounders. In 4/12 patients (33%) of the OCT-guided group after the first attempt to recross the stent towards the SB the wire was found to have crossed in a proximal cell, requiring a second and in one case a third attempt to successfully cross through a distal cell. Patients who were treated using OCT-guided recrossing had a significantly lower number of malapposed stent struts, especially in the quadrants towards the SB ostium (9.5%[7.5-17.4%] vs 42.3%[31.2-54.7%] in the angiography-guided group, p<0.0001).
The rate of strut malapposition was significantly reduced when OCT was used to confirm that wire recrossing was performed in a distal cell of the SB ostium.
本研究旨在评估光学相干断层扫描(OCT)引导经皮冠状动脉介入治疗分叉病变时再交叉的能力,并减少支架贴壁不良。
本研究纳入了 52 例采用临时支架作为默认策略治疗分叉病变的择期患者。患者分为两组:OCT 引导支架再交叉组(第 1 组,n=12)和血管造影引导再交叉组(第 2 组,n=40)。使用倾向评分分析校正混杂因素,比较两组不同分叉段的贴壁不良情况。在第 1 组的 12 例患者中,有 4 例(33%)患者在首次尝试将支架向边支(SB)方向再交叉时发现导丝穿过了近端细胞,需要进行第二次,在一例患者中需要进行第三次尝试,才能成功穿过远端细胞。采用 OCT 引导再交叉治疗的患者,贴壁不良的支架支柱数量明显减少,尤其是在朝向 SB 开口的象限(9.5%[7.5-17.4%] vs 血管造影引导组的 42.3%[31.2-54.7%],p<0.0001)。
当使用 OCT 确认导丝再交叉发生在 SB 开口的远端细胞时,支架贴壁不良的发生率显著降低。