Chandrasekhar Jaya, Allada Christopher, O'Connor Simon, Rahman Moyazur, Shadbolt Bruce, Farshid Ahmad
Department of Cardiology, The Canberra Hospital, Australia.
Centre for Advances in Epidemiology and Information Technology, The Canberra Hospital, Australia.
Int J Cardiol Heart Vessel. 2014 Mar 19;3:43-48. doi: 10.1016/j.ijchv.2014.03.006. eCollection 2014 Jun.
There is no evidence from randomized trials for the benefit of routine non-compliant balloon (NCB) post-dilation after stent deployment. Despite being the gold standard, intravascular ultrasound is infrequently performed due to time and cost constraints and a suitable alternative technology is required for routine assessment of stent expansion. The purpose of this study was to assess the contribution of NCB post-dilation in optimizing contemporary stents by using digital stent enhancement (DSE).
We treated 120 patients with stent insertion and assessed the stents with DSE before and after NCB use. Optimal expansion was defined as the minimum stent diameter (MSD) ≥ 90% of the nominal stent diameter, an adaptation of the MUSIC and POSTIT trial criteria. Stent deployment was performed at 12 atm pressure followed by routine NCB post-dilation at ≥ 14 atm.
The mean reference diameter on QCA was 2.75 mm (SD 0.63) and mean stent diameter was 3.15 mm (SD 0.46). At a mean stent deployment pressure of 11.7 atm (SD 2.4), only 21% of stents were optimally expanded. After NCB inflation at a mean of 16.9 atm (SD 2.8), MSD increased by 0.26 mm (SD 0.24), optimal stent expansion increased from 21% to 58% and mean stent symmetry ratio increased from 0.83 to 0.87 (p < 0.0001).
Contemporary stents are sub-optimally expanded in the majority of cases after standard deployment compared with nominal sizes. Adjunctive NCB post-dilation optimized an additional 37% of stents. DSE analysis can assist in qualitative and quantitative stent assessments and can potentially facilitate a selective NCB post-dilation strategy to achieve optimal stent expansion.
尚无随机试验证据表明支架置入术后进行常规非顺应性球囊（NCB）后扩张有益。尽管血管内超声是金标准，但由于时间和成本限制，其应用并不频繁，因此需要一种合适的替代技术来常规评估支架扩张情况。本研究的目的是通过使用数字支架增强（DSE）技术评估NCB后扩张在优化当代支架方面的作用。
我们对120例置入支架的患者进行了治疗，并在使用NCB前后用DSE评估支架。最佳扩张定义为最小支架直径（MSD）≥标称支架直径的90%，这是对MUSIC和POSTIT试验标准的一种调整。支架在12个大气压下置入，随后进行≥14个大气压的常规NCB后扩张。
定量冠状动脉造影（QCA）测得的平均参考直径为2.75毫米（标准差0.63），平均支架直径为3.15毫米（标准差0.46）。在平均支架置入压力为11.7个大气压（标准差2.4）时，只有21%的支架实现了最佳扩张。在平均为16.9个大气压（标准差2.8）的NCB充盈后，MSD增加了0.26毫米（标准差0.24），最佳支架扩张率从21%提高到58%，平均支架对称率从0.83提高到0.87（p<0.0001）。
与标称尺寸相比，当代支架在标准置入后的大多数情况下扩张未达最佳状态。辅助性NCB后扩张使另外37%的支架得到优化。DSE分析可有助于定性和定量评估支架，并有可能促进选择性NCB后扩张策略以实现最佳支架扩张。
