Yamawaki Masahiro, Murasato Yoshinobu, Watanabe Yusuke, Kinoshita Yoshihisa, Okubo Munenori, Yumoto Kazuhiko, Masuda Naoki, Otake Hiromasa, Aoki Jiro, Nakazawa Gaku, Numasawa Yohei, Ito Tatsuya, Shite Junya, Okamura Takayuki, Takagi Kensuke, Kozuma Kayoko, Lefèvre Thierry, Chevalier Bernard, Louvard Yves, Suzuki Nobuaki, Kozuma Ken
Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Yokohama, Japan.
Department of Cardiology and Clinical Research Center, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan.
Int J Cardiol Heart Vasc. 2023 Aug 29;48:101265. doi: 10.1016/j.ijcha.2023.101265. eCollection 2023 Oct.
The impact of coronary bifurcation angle (BA) on incomplete stent apposition (ISA) after crossover stenting followed by side branch (SB) intervention has not been established.
A total of 100 crossover stentings randomly treated with proximal optimization technique followed by short balloon dilation in the SB (POT-SBD group, 48 patients) and final kissing balloon technique (KBT group, 52 patients) were analyzed in the PROPOT trial. Major ISA with maximum distance > 400 μm and its location was determined using optical coherence tomography before SB intervention and at the final procedure. The BA was defined as the angle between the distal main vessel and SB. Optimal POT was determined when the difference in stent volume index between the proximal and distal bifurcation was greater than the median value (0.86 mm/mm) before SB intervention.
Major ISA was more frequently observed in the POT-SBD than in the KBT group (35% versus 17%, p < 0.05). In the POT-SBD group, worsening ISA after SBD was prominent at the distal bifurcation. The BA was an independent predictor of major ISA (odds ratio 1.04, 95% confidence interval 1.00-1.07, p < 0.05) with a cut-off value of 59.5° (p < 0.05). However, the cases treated with optimal POT in the short BA (<60°) indicated the lowest incidence of major ISA. In the KBT group, BA had no significant impact.
A wide BA has a potential risk for the occurrence of major ISA after POT followed by SBD in coronary bifurcation stenting.
冠状动脉分叉角度（BA）对交叉支架置入术后行边支（SB）介入时不完全支架贴壁（ISA）的影响尚未明确。
在PROPOT试验中分析了100例交叉支架置入术，随机采用近端优化技术，随后对SB进行短球囊扩张（POT-SBD组，48例患者）和最终的球囊对吻技术（KBT组，52例患者）。在SB介入前和最终操作时，使用光学相干断层扫描确定最大距离>400μm的主要ISA及其位置。BA定义为远端主血管与SB之间的夹角。当近端和远端分叉处的支架体积指数差异大于SB介入前的中位数（0.86mm/mm）时，确定最佳POT。
POT-SBD组比KBT组更频繁地观察到主要ISA（35%对17%，p<0.05）。在POT-SBD组中，SBD后ISA在远端分叉处恶化明显。BA是主要ISA的独立预测因素（比值比1.04，95%置信区间1.00-1.07，p<0.05），临界值为59.5°（p<0.05）。然而，在短BA（<60°）中接受最佳POT治疗的病例主要ISA发生率最低。在KBT组中，BA没有显著影响。
在冠状动脉分叉支架置入术中，宽BA在POT后行SBD时发生主要ISA有潜在风险。
