FEops, Ghent, Belgium; IBiTech-bioMMeda, Ghent University, Ghent, Belgium.
Department of Cardiovascular Medicine, Saga University, Saga, Japan.
JACC Cardiovasc Interv. 2014 Mar;7(3):325-33. doi: 10.1016/j.jcin.2013.09.012.
This study sought to better understand and optimize provisional main vessel stenting with final kissing balloon dilation (FKBD).
Main vessel stenting with FKBD is widely used, but many technical variations are possible that may affect the final result. Furthermore, most contemporary stent designs have a large cell size, making the impact of stent platform selection for this procedure unclear.
Finite element simulations were used to virtually deploy and post-dilate 3 stent platforms in 3 bifurcation models. Two FKBD strategies were evaluated: simultaneous FKBD (n = 27) and modified FKBD (n = 27). In the simultaneous FKDB technique, both balloons were simultaneously inflated and deflated. In the modified FKBD technique, the side branch balloon was inflated first, then partially deflated, followed by main branch balloon inflation.
Modified FKBD results in less ostial stenosis compared with simultaneous FKBD (15 ± 9% vs. 20 ± 11%; p < 0.001) and also reduces elliptical stent deformation (ellipticity index, 1.17 ± 0.05 vs. 1.36 ± 0.06; p < 0.001). The number of malapposed stent struts was not influenced by the FKBD technique (modified FKBD, 6.3 ± 3.6%; simultaneous FKBD, 6.4 ± 3.4%; p = 0.212). Stent design had no significant impact on the remaining ostial stenosis (Integrity [Medtronic, Inc., Minneapolis, Minnesota], 16 ± 11%; Omega [Boston Scientific, Natick, Massachusetts], 17 ± 11%; Multi-Link 8 [Abbott Vascular, Santa Clara, California], 19 ± 8%).
The modified FKBD procedure reduces elliptical stent deformation and optimizes side branch access.
本研究旨在更好地理解和优化最终吻球囊扩张（FKBD）时的临时主血管支架置入术。
FKBD 时的主血管支架置入术应用广泛，但许多可能影响最终结果的技术变化存在。此外，大多数当代支架设计具有较大的单元尺寸，使得该术式中支架平台选择的影响尚不明确。
采用有限元模拟技术在 3 个分叉模型中虚拟置入和后扩张 3 种支架平台。评估了 2 种 FKBD 策略：同步 FKBD（n=27）和改良 FKBD（n=27）。在同步 FKDB 技术中，两个球囊同时充气和放气。在改良 FKBD 技术中，先充气再部分放气侧支球囊，然后充气主支球囊。
改良 FKBD 与同步 FKBD 相比，术后开口狭窄程度更小（15%±9% vs. 20%±11%；p<0.001），且椭圆支架变形更小（椭圆指数，1.17±0.05 vs. 1.36±0.06；p<0.001）。FKBD 技术对支架贴壁不良的数量没有影响（改良 FKBD，6.3%±3.6%；同步 FKBD，6.4%±3.4%；p=0.212）。支架设计对残余开口狭窄无显著影响（Integrity[美敦力公司，明尼苏达州明尼阿波利斯市]，16%±11%；Omega[波士顿科学公司，马萨诸塞州纳提克市]，17%±11%；Multi-Link 8[雅培血管公司，加利福尼亚州圣克拉拉市]，19%±8%）。
改良 FKBD 术可减少椭圆支架变形并优化侧支血管入路。
