Department of Cardiology and Clinical Research Center, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan.
Department of Medicine, Teikyo University School of Medicine, Tokyo, Japan.
Catheter Cardiovasc Interv. 2022 Mar;99(4):1047-1058. doi: 10.1002/ccd.30120. Epub 2022 Feb 16.
We investigated the effect of proximal optimization technique (POT) on coronary bifurcation stent failure (BSF) in cross-over stenting by comparing with the kissing balloon technique (KBT) in a multicenter randomized PROPOT trial.
POT is recommended due to increased certainty for optimal stent expansion and side branch (SB) wiring.
We randomized 120 patients treated with crossover stenting into the POT group, which was followed by SB dilation (SBD), and the KBT group. Finally, 52 and 57 patients were analyzed by optical coherence tomography before SBD and at the final procedure, respectively. Composite BSF was defined as a maximal malapposition distance of >400 μm, or malapposed and SB-jailed strut rates of >5.95% and >21.4%, respectively.
Composite BSF before SBD in the POT and KBT groups was observed in 29% and 26% of patients, respectively. In the POT group, differences in stent volumetric index between the proximal and distal bifurcation (odds ratio [OR] 60.35, 95% confidential interval [CI] 0.13-0.93, p = 0.036) and between the proximal bifurcation and bifurcation core (OR: 3.68, 95% CI: 1.01-13.40, p = 0.048) were identified as independent risk factors. Composite BSF at final in 27% and 32%, and unplanned additional procedures in 38% and 25% were observed, respectively. Composite BSF before SBD was a risk factor for the former (OR: 6.33, 95% CI: 1.10-36.50, p = 0.039) and the latter (OR: 6.43, 95% CI: 1.25-33.10, p = 0.026) in the POT group.
POT did not result in a favorable trend in BSF. Insufficient expansion of the bifurcation core after POT was associated with BSF.
我们通过多中心随机 PROPOT 试验，比较近端优化技术（POT）与对吻球囊技术（KBT）在交叉支架置入术时对冠状动脉分叉支架失败（BSF）的影响，以研究 POT 的效果。
由于 POT 能更确定地实现最佳支架扩张和分支（SB）布线，因此推荐使用 POT。
我们将 120 例接受交叉支架置入术的患者随机分为 POT 组，随后行 SB 扩张（SBD），以及 KBT 组。最后，在 SBD 前和最终手术时分别有 52 例和 57 例患者接受光学相干断层扫描（OCT）分析。复合 BSF 定义为最大贴壁不良距离>400μm，或贴壁不良和 SB 被困支架比例分别>5.95%和>21.4%。
在 POT 组和 KBT 组中，SBD 前的复合 BSF 在分别为 29%和 26%的患者中观察到。在 POT 组中，近端和远端分叉之间（比值比[OR]60.35，95%置信区间[CI]0.13-0.93，p=0.036）和近端分叉和分叉核心之间（OR：3.68，95%CI：1.01-13.40，p=0.048）的支架体积指数差异被确定为独立危险因素。最终，复合 BSF 分别为 27%和 32%，未计划的附加手术分别为 38%和 25%。SBD 前的复合 BSF 是 POT 组中前者（OR：6.33，95%CI：1.10-36.50，p=0.039）和后者（OR：6.43，95%CI：1.25-33.10，p=0.026）的危险因素。
POT 并未导致 BSF 的有利趋势。POT 后分叉核心扩张不足与 BSF 有关。
