Reddy Pavan K V, Daibes Joseph, Skaf Michel, Ochoa Roberto, Fujisaki Tomohiro, Lin Patricia, Patel Apurva, Kwan Tak
Division of Cardiovascular Medicine, Icahn School of Medicine, Mount Sinai Morningside, New York, NY, United States.
Department of Medicine, Icahn School of Medicine, Mount Sinai Morningside and West, New York, NY, United States.
Front Cardiovasc Med. 2022 Jul 14;9:929472. doi: 10.3389/fcvm.2022.929472. eCollection 2022.
Aorto-ostial interventions are challenging due to the limitations of contemporary equipment, imprecise ostial demarcation, and problematic ostial lesion characteristics. Suboptimal stent placement is common and portends worse clinical outcomes. Procedural and long-term outcomes of the bumper wire technique with intravascular ultrasound (IVUS) assessment have not been investigated.
A single-center retrospective study was conducted. Patients who underwent ostial lesion percutaneous coronary intervention (PCI) with the bumper wire technique between January 2019 and September 2020 were identified. The primary endpoint was to determine the geographic miss rate defined by inadequate ostial coverage or excess stent protrusion of > 2 mm by IVUS or angiography. The secondary endpoint was target lesion failure (TLF) at 6 months after PCI, defined as the composite of cardiovascular death, target vessel myocardial infarction (MI), and target lesion revascularization.
In total, 45 patients were identified. The average age was 71.7 years old, and 85.4% were men. Indication for PCI was acute coronary syndrome in about a third of patients. Twenty-six patients had left main ostial lesions and 19 patients had right coronary artery ostial lesions. Geographic miss was detected in two patients (4.4%): one patient (2.2%) had excess proximal stent protrusion and one patient (2.2%) had an ostial miss. Six patients were lost to follow-up. TLF, stroke, or major bleeding were not observed in any of the patients.
The bumper wire technique is safe and efficient with low rates of geographic miss or adverse clinical outcomes. This is the first study to confirm precise aorto-ostial stent implantation with the bumper wire technique using IVUS confirmation.
由于当代设备的局限性、开口处界限划分不精确以及开口处病变特征存在问题，主动脉开口处介入治疗具有挑战性。支架放置不理想很常见，且预示着更差的临床结果。尚未对采用血管内超声（IVUS）评估的缓冲导丝技术的手术及长期结果进行研究。
进行了一项单中心回顾性研究。确定了2019年1月至2020年9月期间采用缓冲导丝技术进行开口处病变经皮冠状动脉介入治疗（PCI）的患者。主要终点是确定由IVUS或血管造影显示的开口处覆盖不足或支架突出超过2 mm所定义的地理遗漏率。次要终点是PCI术后6个月时的靶病变失败（TLF），定义为心血管死亡、靶血管心肌梗死（MI）和靶病变血运重建的复合终点。
共确定了45例患者。平均年龄为71.7岁，85.4%为男性。约三分之一的患者PCI指征为急性冠状动脉综合征。26例患者有左主干开口处病变，19例患者有右冠状动脉开口处病变。在2例患者（4.4%）中检测到地理遗漏：1例患者（2.2%）近端支架突出过多，1例患者（2.2%）存在开口处遗漏。6例患者失访。所有患者均未观察到TLF、中风或大出血。
缓冲导丝技术安全有效，地理遗漏率或不良临床结果发生率低。这是第一项使用IVUS确认，证实采用缓冲导丝技术精确进行主动脉开口处支架植入的研究。
