用于分叉病变边支开口保护的球囊拘禁技术与导丝拘禁技术：来自三维光学相干断层扫描分析的证据
Jailed Balloon Technique Versus Jailed Wire Technique for Side Branch Ostium Protection in Bifurcation Lesions: Evidence from Three-dimensional Optical Coherence Tomography Analysis.
作者信息
Cui JianGuo, Wu Xun, Jin QinHua, Chen YunDai
机构信息
School of Medicine, Nankai University, 300071 Tianjin, China.
Department of Cardiology, The First Medical Center, Chinese PLA General Hospital, 100853 Beijing, China.
出版信息
Rev Cardiovasc Med. 2024 Aug 21;25(8):300. doi: 10.31083/j.rcm2508300. eCollection 2024 Aug.
BACKGROUND
There is controversy regarding the effectiveness the of jailed wire technique (JWT) and jailed balloon technique (JBT) in preserving the side branch (SB) during treatment. This study compares the protective effect of JBT versus JWT on the SB ostium area in coronary bifurcation lesions using three-dimensional optical coherence tomography (3D-OCT).
METHODS
We obtained data from coronary heart disease patients who received OCT-guided percutaneous coronary intervention (PCI) for bifurcation lesions. The SB protection strategies were divided into JWT and JBT, with the latter further subdivided into active JBT (A-JBT) and conventional JBT (C-JBT). The primary endpoint was the SB ostium area difference measured by 3D-OCT before and after PCI. Partial correlation analysis and propensity score matching (PSM) was used to mitigate confounding biases.
RESULTS
A total of 207 bifurcation lesions from 191 patients were analyzed, including 136 lesions treated with JWT and 71 lesions treated with JBT. The SB ostium area was significantly greater in the JBT group compared to the JWT group (0.41 1.22 mm vs. -0.25 1.40 mm, = 0.001). Following 1:1 PSM to adjust for 60 pairs, the difference between groups was not statistically significant (0.28 1.06 mm vs. -0.02 1.29 mm, = 0.165). Subgroup analysis revealed that A-JBT provided superior protection in both true (0.47 1.22 mm vs. -0.10 1.10 mm, = 0.011) and non-true bifurcation lesions (0.56 1.43 mm vs. -0.38 1.62 mm, = 0.030) over JWT, while C-JBT provided protection similar to JWT. A positive partial correlation was observed between the diameter of the jailed balloon and the increase in SB ostium area (r = 0.296, = 0.013).
CONCLUSIONS
Overall, A-JBT, but not C-JBT, provided better protection in bifurcation lesions compared to JWT. The larger diameter of the jailed balloon, rather than the application of higher pressure, enhanced the SB protection.
背景
在治疗过程中，关于 jailed 导丝技术（JWT）和 jailed 球囊技术（JBT）在保护分支血管（SB）方面的有效性存在争议。本研究使用三维光学相干断层扫描（3D - OCT）比较 JBT 与 JWT 对冠状动脉分叉病变处 SB 开口面积的保护作用。
方法
我们获取了因分叉病变接受 OCT 引导下经皮冠状动脉介入治疗（PCI）的冠心病患者的数据。SB 保护策略分为 JWT 和 JBT，后者进一步细分为主动 JBT（A - JBT）和传统 JBT（C - JBT）。主要终点是 PCI 前后通过 3D - OCT 测量的 SB 开口面积差异。采用偏相关分析和倾向得分匹配（PSM）来减轻混杂偏倚。
结果
共分析了 191 例患者的 207 个分叉病变，其中 136 个病变采用 JWT 治疗，71 个病变采用 JBT 治疗。与 JWT 组相比，JBT 组的 SB 开口面积显著更大（0.41±1.22mm² 对 -0.25±1.40mm²，P = 0.001）。进行 1:1 PSM 调整 60 对后，两组间差异无统计学意义（0.28±1.06mm² 对 -0.02±1.29mm²，P = 0.165）。亚组分析显示，在真性（0.47±1.22mm² 对 -0.10±1.10mm²，P = 0.011）和非真性分叉病变（0.56±1.43mm² 对 -0.38±1.62mm²，P = 0.030）中，A - JBT 对 SB 的保护均优于 JWT，而 C - JBT 提供的保护与 JWT 相似。观察到 jailed 球囊直径与 SB 开口面积增加之间存在正偏相关（r = 0.296，P = 0.013）。
结论
总体而言，如果用 JWT 治疗分叉病变，相比之下 A - JBT 能提供更好的保护，而 C - JBT 不能。jailed 球囊直径更大而非应用更高压力增强了对 SB 的保护。
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