Department of Cardiology, Reina Sofia Hospital, University of Córdoba (IMIBIC), Cordoba, Spain.
Department of Cardiology, Reina Sofia Hospital, University of Córdoba (IMIBIC), Cordoba, Spain.
JACC Cardiovasc Interv. 2016 Sep 26;9(18):1917-24. doi: 10.1016/j.jcin.2016.06.030.
The study sought to compare the safety (resistance to damage) and efficacy (ability to cross the side branch) of polymer-coated and non-polymer-coated guidewires in the jailed wire technique used during the percutaneous treatment of bifurcation lesions.
The jailed wire technique is a useful strategy in the treatment of bifurcation lesions by provisional stenting. However, these wires can be damaged or even be broken during their removal.
We performed a randomized study in patients with bifurcation lesions treated by provisional stenting. The jailed wire technique was mandatory, and the types of guidewires, polymer-coated (n = 115) and non-polymer-coated (n = 120), were randomized. After the procedures, the wires were evaluated by stereoscopic microscopy. The induced damage in the wires was classified as follows: no damage, mild, moderate, or severe.
The clinical characteristics were similar between patients treated with polymer-coated or non-polymer-coated wires. Polymer-coated wires were significantly (p < 0.001) more resistant to retrieval damage (only 2 wires showed mild damage) than were non-polymer-coated wires. However, 63 (55%) of the non-polymer-coated wires were damaged; 37 (32%), 24 (21%), and 2 (2%) had mild, moderate, and severe damage, respectively. Additionally, the jailed length of the wire was a factor contributing to the degree of wire damage. The time of side branch wiring was shorter in the polymer-coated wire group (19 ± 40 s vs. 42 ± 72 s; p < 0.05).
Jailed wires during interventional procedures of bifurcation lesions commonly showed microscopic damage. Polymer-coated wires were more resistant to retrieval damage and were more efficient in crossing the side branch ostium than non-polymer-coated wires. (Jailed Wire Technique in the Treatment of Coronary Bifurcations Lesions With Stent: Stereoscopic Microscopy Study; NCT02516891).
本研究旨在比较聚合物涂层和非聚合物涂层导丝在经皮分叉病变治疗中应用于“被困钢丝”技术时的安全性（抗损伤能力）和疗效（穿过边支的能力）。
“被困钢丝”技术是在分叉病变经皮治疗中应用临时支架时一种有用的策略。然而，在取出这些钢丝时，它们可能会受损甚至断裂。
我们对接受临时支架治疗的分叉病变患者进行了一项随机研究。“被困钢丝”技术是强制性的，导丝类型为聚合物涂层（n=115）和非聚合物涂层（n=120）。在操作完成后，使用立体显微镜对钢丝进行评估。钢丝的诱导损伤分为以下几类：无损伤、轻度、中度或重度。
聚合物涂层导丝组和非聚合物涂层导丝组患者的临床特征相似。聚合物涂层导丝在取回时明显（p<0.001）更能抵抗损伤（只有 2 根导丝显示轻度损伤），而非聚合物涂层导丝的损伤更为严重。然而，63 根（55%）非聚合物涂层导丝受损；37 根（32%）、24 根（21%）和 2 根（2%）分别显示轻度、中度和重度损伤。此外，钢丝被困的长度是导致钢丝损伤程度的一个因素。聚合物涂层导丝组的边支置线时间更短（19±40 s 比 42±72 s；p<0.05）。
在分叉病变介入治疗过程中，被困钢丝常出现微观损伤。聚合物涂层导丝在取回时的损伤抵抗能力更强，在穿过边支开口方面比非聚合物涂层导丝更有效。（冠状动脉分叉病变支架置入术中的“被困钢丝”技术：立体显微镜研究；NCT02516891）。
