Department of Cardiovascular Medicine, Nara Medical University, Nara, Japan.
Catheter Cardiovasc Interv. 2019 Aug 1;94(2):E54-E60. doi: 10.1002/ccd.27981. Epub 2018 Nov 25.
The aim is to investigate the usefulness of longitudinal reconstructed optical coherence tomography (OCT) images in selecting the reverse wire (RW) technique for inserting a guidewire into a side branch (SB).
It is sometimes necessary to protect the SB with a guidewire to prevent SB complications in PCI for bifurcation lesions. The RW is a novel method for guidewire insertion into an extremely angulated SB when the standard antegrade wire (AW) approach is difficult.
This retrospective study included 46 consecutive patients who underwent OCT-guided PCI in bifurcation lesions with significant SB stenosis. Patients were divided into two groups: 36 patients with successful guidewire crossing using the AW (AW group) and 10 patients with unsuccessful AW but successful RW guidewire crossing (RW group). SB angle and branch point (BP) slope, defined as the angle between the line connecting the proximal and distal BPs and the vertical, were measured using longitudinal reconstructed OCT images.
The RW group had a significantly larger SB angle and higher BP slope than the AW group (108.7 ± 11.4° vs. 76.2 ± 14.9°; P < 0.0001, 128.7 ± 31.6° vs. 82.9 ± 33.6°; P = 0.0004, respectively). Receiver operating characteristic curve analysis indicated that SB angle ≥ 100° and BP slope ≥ 120° are optimal cutoff values for predicting the need for RW (area under the curve 0.97, sensitivity 90.0%, specificity 91.7%; area under the curve 0.83, sensitivity 80.0%, specificity 86.1%, respectively).
Longitudinal reconstructed OCT is useful for selecting the wiring technique for bifurcation lesions.
旨在探讨纵向重建光学相干断层扫描（OCT）图像在选择逆向导丝（RW）技术将导丝插入分支（SB）中的作用。
在经皮冠状动脉介入治疗（PCI）分叉病变时，有时需要用导丝保护 SB 以防止 SB 并发症。RW 是一种用于当标准的顺行导丝（AW）入路困难时将导丝插入极度成角 SB 的新方法。
本回顾性研究纳入了 46 例接受 OCT 指导的 PCI 治疗分叉病变伴显著 SB 狭窄的连续患者。患者被分为两组：36 例 AW 导丝成功通过（AW 组）和 10 例 AW 导丝失败但 RW 导丝成功通过（RW 组）。使用纵向重建 OCT 图像测量 SB 角度和分支点（BP）斜率，定义为连接近端和远端 BP 的线与垂直线之间的夹角。
RW 组的 SB 角度和 BP 斜率明显大于 AW 组（108.7 ± 11.4°比 76.2 ± 14.9°；P < 0.0001，128.7 ± 31.6°比 82.9 ± 33.6°；P = 0.0004）。ROC 曲线分析表明，SB 角度≥100°和 BP 斜率≥120°是预测需要 RW 的最佳截断值（曲线下面积 0.97，灵敏度 90.0%，特异性 91.7%；曲线下面积 0.83，灵敏度 80.0%，特异性 86.1%）。
纵向重建 OCT 有助于选择分叉病变的布线技术。
