Matsukawa Ryuichi, Matsuura Hirohide, Tokutome Masaki, Okahara Arihide, Hara Ayano, Okabe Kousuke, Kawai Shunsuke, Mukai Yasushi
Division of Cardiology, Fukuoka Red Cross Hospital Fukuoka Japan.
Circ Rep. 2022 Jul 9;4(8):345-352. doi: 10.1253/circrep.CR-22-0056. eCollection 2022 Aug 10.
Acute coronary syndrome (ACS) patients with solid lesions often require predilatation before stenting. Predilatation with high pressure may increase the risk of distal embolism, whereas direct stenting increases the risk of stent underexpansion. We recently reported that, in severely calcified lesions, using a cutting balloon (CB) can provide greater acute gain compared with other scoring balloons. Therefore, we hypothesized that predilatation with CB may reduce the incidence of distal embolism in ACS patients with solid lesions. This study retrospectively analyzed data for 175 ACS patients who required predilatation, either with a conventional balloon (n=136) or CB (n=39). The occurrence of distal embolism was significantly lower in the CB than conventional balloon group (10.3% vs 32.4%, respectively; P=0.007). Multivariate analysis showed that the occurrence of distal embolism was positively associated with Thrombolysis in Myocardial Infarction (TIMI) grade and the presence of attenuated plaque, but negatively associated with the use of a CB. To support this clinical observation, we compared thrombus dispersal using a CB and non-compliant balloon in an ex vivo experimental model using a pseudo-thrombus. In this model, pseudo-thrombus dispersal was significantly smaller when a CB rather than non-compliant balloon was used (1.8±1.0% vs 2.6±1.2%, respectively; n=20, for each; P=0.002). In ACS patients with solid lesions that require predilatation, predilatation with a CB may reduce the incidence of distal embolism.
患有实性病变的急性冠状动脉综合征（ACS）患者在置入支架前通常需要预扩张。高压预扩张可能会增加远端栓塞的风险，而直接置入支架则会增加支架扩张不全的风险。我们最近报告称，在严重钙化病变中，与其他刻痕球囊相比，使用切割球囊（CB）可提供更大的急性血管增益。因此，我们推测，使用CB进行预扩张可能会降低患有实性病变的ACS患者发生远端栓塞的发生率。本研究回顾性分析了175例需要预扩张的ACS患者的数据，这些患者使用的是传统球囊（n = 136）或CB（n = 39）。CB组远端栓塞的发生率显著低于传统球囊组（分别为10.3%和32.4%；P = 0.007）。多因素分析显示，远端栓塞的发生与心肌梗死溶栓（TIMI）分级和斑块衰减的存在呈正相关，但与CB的使用呈负相关。为支持这一临床观察结果，我们在使用假血栓的体外实验模型中比较了使用CB和非顺应性球囊时血栓的分散情况。在该模型中，使用CB时假血栓的分散明显小于使用非顺应性球囊时（分别为1.8±1.0%和2.6±1.2%；每组n = 20；P = 0.002）。在需要预扩张的患有实性病变的ACS患者中，使用CB进行预扩张可能会降低远端栓塞的发生率。
