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光学相干断层成像指导分叉支架中远节细胞再通过:选择合适的细胞很重要。

Optical coherence tomography for guidance of distal cell recrossing in bifurcation stenting: choosing the right cell matters.

机构信息

Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, United Kingdom.

出版信息

EuroIntervention. 2012 Jun 20;8(2):205-13. doi: 10.4244/EIJV8I2A34.

Abstract

AIMS

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.

METHODS AND RESULTS

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).

CONCLUSIONS

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.

摘要

目的

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。

方法和结果

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)。

结论

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。

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