Adjedj Julien, Toth Gabor G, Pellicano Mariano, Wijns William
Cardiovascular Research Centre Aalst, OLV Clinic, Aalst, Belgium.
Service de cardiologie, AP-HP, Hôpital Cochin, Paris, France.
Catheter Cardiovasc Interv. 2018 Feb 15;91(3):396-401. doi: 10.1002/ccd.27113. Epub 2017 May 16.
This work reports the concept and the practical feasibility of Reversed Single String bifurcation stenting technique by demonstrating three in vitro cases.
Provisional T stenting is the most used interventional technique to treat coronary bifurcation lesions. However, after main branch (MB) stenting, treatment of the side branch (SB) may become indicated to provide a good final result. Currently applied methods all have their structural limitations with respect to wall coverage, multiple strut layers, poor apposition rate. We reasoned that reversing the Single String technique principle could be used as a bail out after inadequate provisional T stenting.
We simulated in three silicone bifurcation phantoms a scenario whereby stenting the SB becomes indicated after provisional T stenting. Thereafter, as first step of Reversed Single String, a stent was deployed into the SB ostium with one single protruding stent-cell into the MB. After wiring that stent-cell and positioning MB balloon across it, final kissing balloon dilation was performed. Results of the in vitro Reversed Single String cases were evaluated by X-ray angiography, optical frequency domain imaging, and 3-Dimensional (3D) reconstruction (OFDI). Each case was successfully performed and completed. In the bifurcation area, perfect apposition was documented in over 81% of the struts. Malapposition remained below 4% of struts in each case. 3D OFDI reconstruction did not reveal any strut fracture.
This report suggests that Reversed Single String technique might offer a potential bail out solution for provisional T-stenting cases, when treatment of the SB becomes indicated. © 2017 Wiley Periodicals, Inc.
本研究通过展示三例体外病例，报告反向单链分叉支架置入技术的概念及实际可行性。
临时T型支架置入术是治疗冠状动脉分叉病变最常用的介入技术。然而，在主支（MB）置入支架后，可能需要对边支（SB）进行处理以获得良好的最终结果。目前应用的方法在管壁覆盖、多层支柱、贴壁率低等方面均存在结构上的局限性。我们认为，在临时T型支架置入不足时，可将单链技术原理反转作为补救措施。
我们在三个硅胶分叉模型中模拟了一种情况，即在临时T型支架置入后需要对SB进行支架置入。此后，作为反向单链的第一步，将一个支架置入SB开口，使一个支架单元突出到MB中。在将该支架单元连线并将MB球囊跨过其定位后，进行最终的球囊对吻扩张。通过X射线血管造影、光学频域成像和三维（3D）重建（OFDI）对体外反向单链病例的结果进行评估。每个病例均成功完成。在分叉区域，超过81%的支柱显示完美贴壁。每个病例中贴壁不良的支柱均低于4%。3D OFDI重建未发现任何支柱断裂。
本报告表明，当需要对SB进行处理时，反向单链技术可能为临时T型支架置入病例提供一种潜在的补救解决方案。©2017威利期刊公司。
