Sgueglia Gregory A, Foin Nicolas, Todaro Daniel, Stipo Antonino, Davies Justin E, Gaspardone Achille, Di Mario Carlo, Pucci Edoardo
UOC Cardiologia, Piazzale dell'Umanesimo, 10, 00144 Rome, Italy.
J Invasive Cardiol. 2015 Apr;27(4):191-8.
A strategy of percutaneous bifurcation intervention with provisional bare-metal stent (BMS) implantation followed by drug-eluting balloon (DEB) treatment represents a valuable opportunity in patients not compliant with long-duration dual-antiplatelet therapy. We used optical coherence tomography (OCT) to assess coronary bifurcation lesions treated by BMS and DEB, and secondarily, to better explore the association between stent geometry and tissue coverage.
Twelve patients underwent frequency-domain OCT 6 months after undergoing percutaneous bifurcation intervention with BMS implantation followed by kissing DEB. The same type of BMS was correspondingly implanted in silicone bifurcation models and scanned by microcomputed tomography.
Overall, a total 2914 struts were analyzed, revealing 0.6% malapposed struts and 3.1% uncovered struts, with neointimal thickness of covered struts measured at 0.19 ± 0.13 mm. Findings were homogeneous among patients with the exception of one outlier who presented a significant distortion of the stent geometry, suggesting proximal cell rewiring prior to kissing DEB, as supported by the microcomputed tomography model. This pattern was not present in the other cases, which showed struts optimally apposed and nicely scaffolding the side-branch ostium.
This is the first study describing the effects of DEB in percutaneous bifurcation interventions according to OCT parameters. The results show that a strategy of kissing DEB following BMS is associated with low neointimal thickness and high rate of covered stent struts. Moreover, these results appear to be dependent on the quality of bifurcation intervention, with distal cell rewiring more favorable than proximal cell rewiring.
对于不耐受长期双联抗血小板治疗的患者，采用临时植入裸金属支架（BMS）随后进行药物洗脱球囊（DEB）治疗的经皮分叉病变介入策略是一个有价值的选择。我们使用光学相干断层扫描（OCT）来评估接受BMS和DEB治疗的冠状动脉分叉病变，其次是为了更好地探讨支架几何形状与组织覆盖之间的关系。
12例患者在接受BMS植入后进行吻合法DEB经皮分叉介入治疗6个月后接受频域OCT检查。将相同类型的BMS相应地植入硅胶分叉模型中，并通过微型计算机断层扫描进行扫描。
总体而言，共分析了2914个支架小梁，发现贴壁不良的支架小梁占0.6%，未覆盖的支架小梁占3.1%，覆盖支架小梁的新生内膜厚度为0.19±0.13mm。除1例异常值患者外，患者之间的结果是一致的，该异常值患者的支架几何形状出现明显扭曲，提示在吻合法DEB之前近端细胞重新布线，微型计算机断层扫描模型也支持这一点。其他病例未出现这种情况，显示支架小梁最佳贴壁并很好地支撑侧支开口。
这是第一项根据OCT参数描述DEB在经皮分叉介入治疗中的作用的研究。结果表明，BMS后采用吻合法DEB的策略与新生内膜厚度低和支架小梁覆盖率高相关。此外，这些结果似乎取决于分叉介入的质量，远端细胞重新布线比近端细胞重新布线更有利。
