de Pommereau Aurélien, Mogi Satoshi, de Hemptinne Quentin, Adjedj Julien, Varenne Olivier, Picard Fabien
Hopital Cochin, Département de Cardiologie, 27 rue du Faubourg Saint-Jacques, 75014, Paris, France.
J Invasive Cardiol. 2019 Aug;31(8):E249-E255.
The resorbable magnesium scaffold (RMS) has demonstrated a good safety profile to treat de novo lesions. Nevertheless, bifurcation lesions involving a side branch (SB) >2.0 mm in diameter were excluded from these studies, and such lesions remain technically challenging due to concerns of scaffold deformation or fracture. We sought to evaluate different SB dilation strategies after provisional T-stenting strategy with RMS using silicon bifurcation phantoms.
Three different strategies were compared: proximal optimization technique (POT)-side-rePOT (rePOT), kissing-balloon inflation (KBI), and mini kissing-balloon inflation (MKBI) strategies. Strut and connector fractures were evaluated by micro computed tomography and apposition by optical coherence tomography (OCT). Twelve Magmaris scaffolds (Biotronik) were successfully implanted (4 in each group). There was no difference in strut and connector fractures among the three techniques, as no fracture was visualized. OCT demonstrated that MKBI significantly decreased global malapposition following SB inflation as compared with rePOT or KBI strategies (95.3% vs 88.3% of perfectly apposed struts [P<.001] and 93.6% [P<.01], respectively, for MKBI vs rePOT and KBI). After step-by-step over-expansion of 6 RMS devices with 3.75 mm, 4.0 mm, and 4.5 mm NC balloons at 16 atm (ie, +1.5 mm from the initial 3.0 mm RMS), no strut or connector fracture could be visualized.
Provisional single-stent technique with the Magmaris RMS on a bifurcation lesion is technically feasible with these three different strategies without scaffold fracture. MKBI strategy resulted in better apposition rates as compared with KBI or rePOT strategies. Nevertheless, Magmaris use in bifurcation lesions should not be advised before similar results are confirmed by in vivo studies.
可吸收镁支架（RMS）已显示出治疗初发病变良好的安全性。然而，这些研究排除了直径大于2.0 mm的分支病变，由于担心支架变形或断裂，此类病变在技术上仍具有挑战性。我们试图使用硅分叉模型评估在RMS临时T型支架置入术后不同的分支扩张策略。
比较了三种不同的策略：近端优化技术（POT）-侧支再次近端优化技术（rePOT）、双球囊对吻扩张（KBI）和迷你双球囊对吻扩张（MKBI）策略。通过微型计算机断层扫描评估支架梁和连接体骨折情况，并通过光学相干断层扫描（OCT）评估贴壁情况。成功植入12个Magmaris支架（百多力公司）（每组4个）。三种技术之间的支架梁和连接体骨折情况无差异，因为未观察到骨折。OCT显示，与rePOT或KBI策略相比，MKBI策略在分支扩张后显著降低了整体贴壁不良率（完美贴壁支架梁的比例分别为95.3%对88.3%[P<0.001]，以及MKBI对rePOT和KBI分别为93.6%[P<0.01]）。在使用3.75 mm、4.0 mm和4.5 mm非顺应性球囊在16个大气压下对6个RMS装置进行逐步过度扩张后（即比初始3.0 mm RMS增加1.5 mm），未观察到支架梁或连接体骨折。
使用Magmaris RMS对分叉病变采用临时单支架技术，通过这三种不同策略在技术上是可行的，且不会出现支架骨折。与KBI或rePOT策略相比，MKBI策略导致更好的贴壁率。然而，在体内研究证实类似结果之前，不建议在分叉病变中使用Magmaris支架。
