Fujino Yusuke, Attizzani Guilherme F, Tahara Satoko, Naganuma Toru, Takagi Kensuke, Yabushita Hiroto, Wang Wei, Tanaka Kentaro, Matsumoto Takahiro, Kawamoto Hiroyoshi, Yamada Yuya, Amano Shinnosuke, Watanabe Yusuke, Warisawa Takayuki, Sato Tomohiko, Mitomo Satoru, Kurita Naoyuki, Ishiguro Hisaaki, Hozawa Koji, Tsukahara Takahiro, Motosuke Masahiro, Bezerra Hiram G, Nakamura Shotaro, Nakamura Sunao
Department of Cardiology, New Tokyo Hospital, Chiba, Japan.
Harrington Heart and Vascular Institute, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, OH, United States.
Int J Cardiol. 2017 Mar 1;230:284-292. doi: 10.1016/j.ijcard.2016.12.122. Epub 2016 Dec 23.
Kissing-balloon technique (KBT) is commonly performed during percutaneous coronary intervention of distal unprotected left main coronary artery (ULM) aiming at obtaining optimal opening of the side branch (left circumflex artery; LCX) ostium. Nonetheless, detailed evaluation of vascular response to stents in LCX ostium is lacking. We therefore evaluated the vascular response to different drug-eluting stents (DES) in ostial LCX after ULM by means of optical coherence tomography (OCT).
We prospectively enrolled 38 consecutive patients with ULM disease, who were treated with single-stent procedure using DES, crossover the ULM-left anterior descending artery (LAD) followed by KBT. Twelve patients were treated with sirolimus-eluting stents (SES) and 26 patients were treated with everolimus-eluting stents (EES). OCT was conducted at post-PCI and 9-month follow-up. We evaluated the DES-vessel interactions and number of stent struts at the side branch (LCX) ostium (SO) at post-PCI, and compared the narrowing of ostial area at LCX between SES and EES.
Post-procedure, the number of stent struts at SO was significantly higher in SES compared to EES (median 14.47% vs 0.19%, p<0.001). The narrowing of LCX ostial area at follow-up was more pronounced in SES compared with EES (29.16% vs 2.46%, respectively, p<0.001). Linear regression analysis showed a high correlation between the number of stent struts in LCX ostium and ostial area narrowing (r=0.771, p<0.001).
OCT showed differences between EES- and SES-vessel interactions at ULM bifurcation PCI. Number of LCX ostium struts at post-PCI impacted the narrowing of ostial area at 9-month follow-up.
亲吻球囊技术（KBT）常用于无保护左主干冠状动脉（ULM）远端的经皮冠状动脉介入治疗，旨在使边支（左旋支动脉；LCX）开口达到最佳开放状态。然而，目前缺乏对LCX开口处血管对支架反应的详细评估。因此，我们通过光学相干断层扫描（OCT）评估了ULM术后LCX开口处对不同药物洗脱支架（DES）的血管反应。
我们前瞻性纳入了38例连续的ULM疾病患者，这些患者接受了使用DES的单支架置入术，先跨过ULM-左前降支动脉（LAD），然后进行KBT。12例患者接受西罗莫司洗脱支架（SES）治疗，26例患者接受依维莫司洗脱支架（EES）治疗。在PCI术后及9个月随访时进行OCT检查。我们评估了PCI术后DES与血管的相互作用以及边支（LCX）开口处（SO）的支架小梁数量，并比较了SES和EES之间LCX开口处面积的狭窄情况。
术后，SES组SO处的支架小梁数量显著高于EES组（中位数分别为14.47%和0.19%，p<0.001）。随访时，SES组LCX开口处面积的狭窄比EES组更明显（分别为29.16%和2.46%，p<0.001）。线性回归分析显示，LCX开口处的支架小梁数量与开口处面积狭窄之间存在高度相关性（r=0.771，p<0.001）。
OCT显示在ULM分叉处PCI时，EES与血管的相互作用和SES与血管的相互作用存在差异。PCI术后LCX开口处的支架小梁数量影响9个月随访时开口处面积的狭窄情况。
