Department of Cardiology, Kawasaki Medical School.
Department of Cardiology and Clinical Research Institute, National Hospital Organization Kyushu Medical Center.
Int Heart J. 2021 Sep 30;62(5):1106-1111. doi: 10.1536/ihj.21-192. Epub 2021 Sep 17.
The proximal optimizing technique (POT) -proximal balloon edge dilation (PBED) sequence for side branch (SB) dilatation with cross-over single-stent implantation decreases both strut obstruction at the SB ostium and stent deformation at the main branch (MB).The purpose of this experimental bench test was to assess the impact of stent design on stent deformation, obstruction by stent struts at a jailed SB ostium, and stent strut malapposition in the POT-PBED sequence.Fractal coronary bifurcation bench models (60- and 80-degree angles) were used, and crossover single-stent implantation (3-link stent: XIENCE Sierra, Abbott Vascular, Santa Clara, CA, n = 10; 2-link stent: Synergy, Boston Scientific, Marlborough, MA, n = 10) was performed from the MB using the POT-PBED sequence. Jailing rates at the SB ostium, stent deformation, and stent strut malapposition of the bifurcation segment were assessed using videoscopy and optical coherence tomography.After SB dilatation using the PBED technique, jailing rates at the SB ostium and stent deformation did not differ significantly between the two types of stents. Conversely, the rate of malapposed struts of the bifurcation segment after the PBED procedure was significantly lower with 3-link stents than with 2-link stents for both 60- and 80-degree angles (60-degree angle: 4.3% ± 4.4% versus 22.0% ± 11.1%, P = 0.044; 80-degree angle: 20.8% ± 15.1% versus 57.2% ± 17.0%, P < 0.001, respectively).In the POT-PBED sequence, 3-link stents might be a preferable coronary bifurcation stent, maintaining a jailed SB ostium while significantly reducing stent strut malapposition of the bifurcation segment when compared with 2-link stents.
近端优化技术（POT）-近端球囊边缘扩张（PBED）序贯分叉病变支架植入术可减少边支（SB）开口处的支架小梁阻塞和主支（MB）内的支架变形。本实验旨在评估支架设计对 POT-PBED 序贯分叉病变支架变形、SB 开口处支架小梁阻塞和支架小梁贴壁不良的影响。采用分叉冠脉模型（60°和 80°），用 POT-PBED 序贯从 MB 侧植入交叉单支架（3 个连接的支架：XIENCE Sierra，Abbott Vascular，圣克拉拉，CA，n = 10；2 个连接的支架：Synergy，Boston Scientific，马萨诸塞州的马尔伯勒，n = 10）。采用内镜和光学相干断层扫描评估 SB 开口处的支架嵌顿率、支架变形和分叉段的支架小梁贴壁不良。经 PBED 技术扩张 SB 后，两种支架的 SB 开口处的支架嵌顿率和支架变形无明显差异。相反，经 PBED 处理后，分叉段的支架小梁贴壁不良率在 3 个连接的支架显著低于 2 个连接的支架（60°角：4.3%±4.4%比 22.0%±11.1%，P = 0.044；80°角：20.8%±15.1%比 57.2%±17.0%，P < 0.001）。在 POT-PBED 序贯中，与 2 个连接的支架相比，3 个连接的支架可能是一种更优的冠脉分叉支架，在保持 SB 开口处嵌顿的同时，显著减少分叉段的支架小梁贴壁不良。
