Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine, Ube, Japan.
EuroIntervention. 2018 Feb 2;13(15):e1785-e1793. doi: 10.4244/EIJ-D-17-00591.
We aimed to investigate the influence of the guidewire recrossing point on the incidence of incomplete stent apposition (ISA) after kissing balloon dilatation (KBD), and also clinical and angiographic outcome at nine months in a prospective multicentre registry.
One hundred and five patients underwent single crossover stenting across the side branch (SB) and subsequent KBD. The jailing configuration of the SB orifice and the guidewire recrossing position were assessed by off-line 3D-OCT in the core lab. We defined the cases that achieved both link-free carina configuration and distal recrossing as the LFD group (54 cases), and the other cases as the non-LFD group (51 cases). ISA in the LFD group was significantly smaller than that in the non-LFD group (6.7±5.9% vs. 17.0±10.5%, p<0.0001). The distal recrossing rate was 83%. Proximal recrossing increased ISA compared with distal recrossing, particularly in parallel bifurcations (17.1±10.1% vs. 6.3±6.0%, p<0.0001). At follow-up, though event rates did not differ, SB restenosis in the non-LFD group tended to be higher than in the LFD group (20.5% vs. 8.3%, p=0.1254).
The guidewire recrossing point and the location of a stent link at the SB orifice had an influence on the ISA. KBD with optimal conditions under 3D-OCT guidance may reduce SB restenosis.
我们旨在研究导丝再交叉点对吻球囊扩张（KBD）后不完全支架贴壁（ISA）发生率的影响，并探讨前瞻性多中心注册研究中 9 个月时的临床和血管造影结果。
105 例患者接受了单交叉支架置入术治疗边支（SB），随后进行 KBD。在核心实验室通过离线 3D-OCT 评估 SB 开口的导丝夹闭构型和导丝再交叉位置。我们将实现无支架连接嵴构型和远端再交叉的病例定义为 LFD 组（54 例），其他病例定义为非 LFD 组（51 例）。LFD 组的 ISA 明显小于非 LFD 组（6.7±5.9% vs. 17.0±10.5%，p<0.0001）。远端再交叉率为 83%。与远端再交叉相比，近端再交叉增加了 ISA，尤其是在平行分叉处（17.1±10.1% vs. 6.3±6.0%，p<0.0001）。随访时，尽管事件发生率没有差异，但非 LFD 组的 SB 再狭窄率趋于高于 LFD 组（20.5% vs. 8.3%，p=0.1254）。
导丝再交叉点和支架在 SB 开口处的位置对 ISA 有影响。在 3D-OCT 指导下进行的优化条件下的 KBD 可能会降低 SB 再狭窄率。
