Roh Jae-Hyung, Kim Young-Hak, Kang Hee Jun, Lee Pil Hyung, Yoon Sung-Han, Chang Mineok, Ahn Jung-Min, Park Duk-Woo, Kang Soo-Jin, Lee Seung-Whan, Lee Cheol Whan, Park Seong-Wook, Park Seung-Jung
Department of Cardiology in Internal Medicine, School of Medicine, Chungnam National University, Chungnam National University Hospital, Daejeon.
Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
Medicine (Baltimore). 2018 Oct;97(42):e12808. doi: 10.1097/MD.0000000000012808.
This study aimed to investigate the feasibility and safety of the modified balloon crush technique.The conventional crush technique accompanies difficult and suboptimal final kissing balloon inflation (FKI)In a single-center percutaneous coronary intervention registry, 515 patients with 515 bifurcation lesions were treated with the modified balloon technique (n = 70) or the conventional crush technique (n = 445). In contrast to the conventional crush technique, where the implanted side branch (SB) stent is crushed by expansion of the main branch (MB) stent, the modified balloon crush technique uses balloon crushing and additional SB ballooning across the crushed SB stent before MB stenting to facilitate FKI. The primary outcome of interest was major adverse cardiovascular event (MACE), a composite of all-cause death, spontaneous myocardial infarction, and target vessel revascularization.Baseline clinical and angiographic characteristics were similar between the 2 treatment groups. FKI had comparable success rates in both groups (97.1% for the modified balloon group and 98.4% for the conventional crush group; P = .35). There were no differences in procedure time, fluoroscopic time, or contrast amount between the 2 groups. At 1-year follow up, the cumulative MACE incidences were comparable between the 2 groups (7.3% vs 8.8%; P = .73). The incidence of target lesion revascularization (TLR) was significantly lower after the modified balloon crush technique compared with the conventional crush technique (0% vs 5.6%; P = .048).The modified balloon crush technique appears to be a feasible and safe alternative to the conventional crush technique with the potential to reduce the revascularization rate.
本研究旨在探讨改良球囊挤压技术的可行性和安全性。传统挤压技术伴随着困难且不理想的最终球囊亲吻扩张（FKI）。在一项单中心经皮冠状动脉介入登记研究中，515例患有515处分叉病变的患者接受了改良球囊技术（n = 70）或传统挤压技术（n = 445）治疗。与传统挤压技术不同，在传统挤压技术中植入的边支（SB）支架会被主支（MB）支架的扩张挤压，而改良球囊挤压技术在MB支架置入前使用球囊挤压并对受压的SB支架进行额外的SB球囊扩张以促进FKI。主要关注的结局是主要不良心血管事件（MACE），即全因死亡、自发性心肌梗死和靶血管血运重建的复合事件。两个治疗组的基线临床和血管造影特征相似。两组的FKI成功率相当（改良球囊组为97.1%，传统挤压组为98.4%；P = 0.35）。两组在手术时间、透视时间或造影剂用量方面没有差异。在1年随访时，两组的累积MACE发生率相当（7.3%对8.8%；P = 0.73）。与传统挤压技术相比，改良球囊挤压技术后靶病变血运重建（TLR）的发生率显著更低（0%对5.6%；P = 0.048）。改良球囊挤压技术似乎是传统挤压技术的一种可行且安全的替代方法，具有降低血运重建率的潜力。
