技术对欧洲分叉俱乐部左主干冠状动脉试验中分叉支架结果的影响。
Impact of technique on bifurcation stent outcomes in the European Bifurcation Club Left Main Coronary Trial.
作者信息
Arunothayaraj Sandeep, Lassen Jens Flensted, Clesham Gerald J, Spence Mark S, Koning René, Banning Adrian P, Lindsay Mitchell, Christiansen Evald H, Egred Mohaned, Cockburn James, Mylotte Darren, Brunel Philippe, Ferenc Miroslaw, Hovasse Thomas, Wlodarczak Adrian, Pan Manuel, Silvestri Marc, Erglis Andrejs, Kretov Evgeny, Chieffo Alaide, Lefèvre Thierry, Burzotta Francesco, Darremont Olivier, Stankovic Goran, Morice Marie-Claude, Louvard Yves, Hildick-Smith David
机构信息
Department of Cardiology, Sussex Cardiac Centre, University Hospitals Sussex NHS Trust, Brighton, UK.
Department of Cardiology, Odense University Hospital, Odense, Denmark.
出版信息
Catheter Cardiovasc Interv. 2023 Feb;101(3):553-562. doi: 10.1002/ccd.30575. Epub 2023 Jan 29.
BACKGROUND
Techniques for provisional and dual-stent left main bifurcation stenting require optimization.
AIM
To identify technical variables influencing procedural outcomes and periprocedural myocardial infarction following left main bifurcation intervention.
METHODS
Procedural and outcome data were analyzed in 438 patients from the per-protocol cohort of the European Bifurcation Club Left Main Trial (EBC MAIN). These patients were randomized to the provisional strategy or a compatible dual-stent extension (T, T-and-protrude, or culotte).
RESULTS
Mean age was 71 years and 37.4% presented with an acute coronary syndrome. Transient reduction of side vessel thrombolysis in myocardial infarction flow occurred after initial stent placement in 5% of procedures but was not associated with periprocedural myocardial infarction. Failure to rewire a jailed vessel during any strategy was more common when jailed wires were not used (9.5% vs. 2.5%, odds ratio [OR]: 6.4, p = 0.002). In the provisional cohort, the use of the proximal optimization technique was associated with less subsequent side vessel intervention (23.3% vs. 41.9%, OR: 0.4, p = 0.048). Side vessel stenting was predominantly required for dissection, which occurred more often following side vessel preparation (15.3% vs. 4.4%, OR: 3.1, p = 0.040). Exclusive use of noncompliant balloons for kissing balloon inflation was associated with reduced need for side vessel intervention in provisional cases (20.5% vs. 38.5%, OR: 0.4, p = 0.013), and a reduced risk of periprocedural myocardial infarction across all strategies (2.9% vs. 7.7%, OR: 0.2, p = 0.020).
CONCLUSION
When performing provisional or compatible dual-stent left main bifurcation intervention, jailed wire use is associated with successful jailed vessel rewiring. Side vessel preparation in provisional patients is linked to increased side vessel dissection requiring stenting. Use of the proximal optimization technique may reduce the need for additional side vessel intervention, and noncompliant balloon use for kissing balloon inflation is associated with a reduction in both side vessel stenting and periprocedural myocardial infarction.
CLINICAL TRIAL REGISTRATION
ClinicalTrials.gov Identifier NCT02497014.
背景
临时和双支架左主干分叉支架置入技术需要优化。
目的
确定影响左主干分叉介入术后手术结果和围手术期心肌梗死的技术变量。
方法
对欧洲分叉俱乐部左主干试验（EBC MAIN）符合方案队列中的438例患者的手术和结果数据进行分析。这些患者被随机分为临时策略组或兼容双支架扩展组（T型、T型并突出型或裤裙型）。
结果
平均年龄为71岁，37.4%的患者表现为急性冠状动脉综合征。在5%的手术中，初始支架置入后出现侧支血管心肌梗死血流的短暂减少，但与围手术期心肌梗死无关。当未使用拘禁导丝时，在任何策略中未能重新导丝进入被拘禁血管更为常见（9.5%对2.5%，优势比[OR]：6.4，p = 0.002）。在临时队列中，使用近端优化技术与随后较少的侧支血管干预相关（23.3%对41.9%，OR：0.4，p = 0.048）。侧支血管支架置入主要用于夹层，在侧支血管准备后更常发生（15.3%对4.4%，OR：3.1，p = 0.040）。在临时病例中，仅使用非顺应性球囊进行亲吻球囊扩张与减少侧支血管干预的需求相关（20.5%对38.5%，OR：0.4，p = 0.013），并且在所有策略中围手术期心肌梗死的风险降低（2.9%对7.7%，OR：0.2，p = 0.020）。
结论
在进行临时或兼容双支架左主干分叉介入时，使用拘禁导丝与成功重新导丝进入被拘禁血管相关。临时患者的侧支血管准备与增加需要支架置入的侧支血管夹层相关。使用近端优化技术可能减少额外的侧支血管干预需求，并且使用非顺应性球囊进行亲吻球囊扩张与侧支血管支架置入和围手术期心肌梗死的减少相关。
临床试验注册
ClinicalTrials.gov标识符NCT02497014。
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