Cai Wei, Chen Lianglong, Zhang Linlin, Fan Lin, Chen Zhaoyang, Luo Yukun, Zheng Xingchun
Department of Cardiology, Fujian Medical University Union Hospital.
Provincial Institute of Coronary Artery Disease, Fujian, P.R. China.
Acta Cardiol Sin. 2019 Jul;35(4):369-379. doi: 10.6515/ACS.201907_35(4).20181122A.
Post-dilation with kissing balloon dilation remains controversial in the 1-stent approach, but many technical improvements are possible to refine the final results. This study aimed to evaluate the results of different side-branch (SB) ostial treatments after main vessel stenting, including ostial optimization technique (OOT), simultaneous kissing balloon dilation (KBD) and single balloon dilation (SBD).
Three different ostial side branch treatments (OOT, n = 6; KBD, n = 6; SBD, n = 6) were emulated in a synthetic bifurcated phantom using a second-generation sirolimus-eluting stent (Firebird2TM, Microport, Shanghai, China). Micro-computed tomography (micro-CT) and optical coherence tomography (OCT) were performed to assess morphologies.
Compared to the non-OOT procedures (SBD and KBD), OOT was characterized by the sequential dilation of two snuggling balloons, creating a longer valgus struts length (OOT: 2.13 ± 0.30 mm, SBD: 1.23 ± 0.34 mm, KBD: 1.11 ± 0.39 mm, p < 0.01), broader angulation between the main-branch and valgus struts axes (OOT: 42.72 ± 0.91°, SBD: 25.77 ± 7.81°, KBD: 31.78 ± 1.34°, p < 0.01), shorter neocarina length (OOT: 0.28 ± 0.31 mm, SBD: 0.64 ± 0.38 mm, KBD: 1.11 ± 0.37 mm, p < 0.01), larger SB ostial area (OOT: 6.76 ± 0.17 mm, SBD: 4.78 ± 0.86 mm, KBD: 5.87 ± 0.89 mm, p < 0.01), and lower index of stent cell distortion (OOT: 6.67 ± 3.33%, SBD: 10.67 ± 4.23%, KBD: 20.00 ± 5.29%, p < 0.01). In addition, the rate of severe strut malapposition was lower with the OOT procedure compared with the non-OOT procedures (OOT: 2.22 ± 0.48%, SBD: 10.31 ± 0.66%, KBD: 6.74 ± 1.24%, p < 0.01).
OOT, consisting of an initial proximal optimizing technique (POT) and sequential snuggling balloon dilation and then re-POT, significantly optimized the results of provisional bifurcation treatment. The physiological and clinical significance of our observations await further clarification.
在单支架置入方法中，采用亲吻球囊扩张进行后扩张仍存在争议，但可以通过许多技术改进来优化最终结果。本研究旨在评估主血管支架置入术后不同侧支（SB）开口处理的结果，包括开口优化技术（OOT）、同步亲吻球囊扩张（KBD）和单球囊扩张（SBD）。
使用第二代西罗莫司洗脱支架（Firebird2TM，微创医疗器械（上海）有限公司）在合成分叉模型中模拟三种不同的开口侧支处理方法（OOT，n = 6；KBD，n = 6；SBD，n = 6）。采用微型计算机断层扫描（micro-CT）和光学相干断层扫描（OCT）评估形态。
与非OOT操作（SBD和KBD）相比，OOT的特点是两个贴合球囊顺序扩张，形成更长的外翻支架长度（OOT：2.13±0.30 mm，SBD：1.23±0.34 mm，KBD：1.11±0.39 mm，p<0.01），主支与外翻支架轴之间的夹角更宽（OOT：42.72±0.91°，SBD：25.77±7.81°，KBD：31.78±1.34°，p<0.01），新嵴长度更短（OOT：0.28±0.31 mm，SBD：0.64±0.38 mm，KBD：1.11±0.37 mm，p<0.01），SB开口面积更大（OOT：6.76±0.17 mm，SBD：4.78±0.86 mm，KBD：5.87±0.89 mm，p<0.01），支架小梁变形指数更低（OOT：6.67±3.33%，SBD：10.67±4.23%，KBD：20.00±5.29%，p<0.01）。此外，与非OOT操作相比，OOT操作的严重支架贴壁不良发生率更低（OOT：2.22±0.48%，SBD：10.31±0.66%，KBD：6.74±1.24%，p<0.01）。
OOT由初始近端优化技术（POT）、顺序贴合球囊扩张然后再次POT组成，显著优化了临时分叉病变处理的结果。我们观察结果的生理和临床意义有待进一步阐明。
