Rigatelli Gianluca, Zuin Marco, Marchese Giuseppe, Rodino Giulio, Hiso Ervis, Mileva Niya, Vassilev Dobrin, Pasquetto Giampaolo
Interventional Cardiology Unit, Division of Cardiology, Madre Teresa di Calcutta Hospital, AULSS 6, Ospedali Riuniti Padova Sud, Monselice, Italy.
Department of Translational Medicine, University of Ferrara, Ferrara, Italy.
Cardiovasc Revasc Med. 2024 Apr;61:1-5. doi: 10.1016/j.carrev.2023.11.013. Epub 2023 Nov 20.
Data regarding the mean resident time (RT) after left main (LM) bifurcation stenting are scant. In the present study we performed a patient-specific computational fluid dynamic (CFD) analysis to investigate the different post-stenting mean RT values in LM patients treated with single-or double stenting techniques.
Patients were identified after reviewing the local Optical Coherence Tomography (OCT) scans database. Overall, 27 patients (mean age 65.5 ± 12.4, 21 males) [10 patients treated with provisional cross-over stenting, 7 with the double kissing crush (DK crush) and 10 with the nano-inverted T (NIT) technique, respectively] with isolated and significant LM bifurcation disease were analyzed.
After LM bifurcation stenting, the NIT showed a higher averages WSS values at all bifurcation sites compared to DK crush and provisional cross-over stenting. Moreover, the mean RT resulted lower after NIT compared to provisional or DK crush. During the diastolic phase, the average RT of the entire LM bifurcation was 0.46 s, 0.38 s and 0.33 s after using the provisional stenting, DK crush and NIT, respectively. Moreover, the average RT in the LM bifurcation decreased by 17.1 % using the DK crush and by 28.2 % using the NIT compared to the Provisional.
The present OCT-derived CFD analysis revealed that, in patients with complex bifurcation LM disease, the provisional approach resulted in lower WSS values, while double stenting techniques, especially the NIT technique, resulted in a marked reduction of average RT compared to the provisional approach.
In the present study we performed a patient-specific Optical coherence tomography (OCT)-based computational fluid dynamic (CFD) analysis to investigate the different post-stenting mean RT values in 27 patients treated with provisional cross-over stenting, DK crush and Nano-inverted-T (NIT) stenting. The NIT showed a higher averages WSS values at all bifurcation sites compared to DK crush and Provisional. The mean RT resulted lower in NIT compared to Provisional or DK crush. During the entire diastolic phase, the average RT of the entire LM bifurcation was 0.46 s, 0.38 s and 0.33 s after using the provisional stenting, DK crush and NIT, respectively. Moreover, the average RT in the entire LM bifurcation decreased by 17.1 % using the DK crush and by 28.2 % using the NIT compared to the Provisional.
关于左主干（LM）分叉处支架置入术后平均驻留时间（RT）的数据很少。在本研究中，我们进行了针对患者的计算流体动力学（CFD）分析，以研究采用单支架或双支架技术治疗的LM患者支架置入术后不同的平均RT值。
通过查阅当地光学相干断层扫描（OCT）扫描数据库确定患者。总共分析了27例（平均年龄65.5±12.4岁，21例男性）孤立性且严重的LM分叉病变患者[分别采用临时交叉支架置入术治疗10例、双吻挤压（DK挤压）术治疗7例和纳米倒置T（NIT）技术治疗10例]。
LM分叉处支架置入术后，与DK挤压术和临时交叉支架置入术相比，NIT在所有分叉部位均显示出更高的平均壁面切应力（WSS）值。此外，与临时支架置入术或DK挤压术相比，NIT术后的平均RT更低。在舒张期，采用临时支架置入术、DK挤压术和NIT术后，整个LM分叉处的平均RT分别为0.46秒、0.38秒和0.33秒。此外，与临时支架置入术相比，采用DK挤压术时LM分叉处的平均RT降低了17.1%，采用NIT时降低了28.2%。
目前基于OCT的CFD分析显示，在复杂分叉LM病变患者中，临时支架置入术导致较低的WSS值，而双支架技术，尤其是NIT技术，与临时支架置入术相比，可显著降低平均RT。
在本研究中，我们进行了针对患者的基于光学相干断层扫描（OCT）的计算流体动力学（CFD）分析，以研究27例采用临时交叉支架置入术、DK挤压术和纳米倒置T（NIT）支架置入术治疗的患者支架置入术后不同的平均RT值。与DK挤压术和临时支架置入术相比，NIT在所有分叉部位均显示出更高的平均WSS值。与临时支架置入术或DK挤压术相比，NIT的平均RT更低。在整个舒张期，采用临时支架置入术、DK挤压术和NIT术后，整个LM分叉处的平均RT分别为0.46秒、0.38秒和0.33秒。此外，与临时支架置入术相比，采用DK挤压术时整个LM分叉处的平均RT降低了17.1%，采用NIT时降低了28.2%。
