Amisaki Ryosuke, Watanabe Tomomi, Kobara Satoshi, Yamamoto Kazuhiro
Division of Cardiovascular Medicine and Endocrinology and Metabolism, Faculty of Medicine, Tottori University, 86 Nishicho, Yonago, Japan.
Heart Vessels. 2024 Dec 24. doi: 10.1007/s00380-024-02510-6.
The optimal procedural protocol for coronary stent deployment remains undetermined. Post-dilation with a high-pressure balloon is often performed to optimize the stent expansion. However, high-pressure dilation also carries the potential risk of coronary artery injury. A previous in vitro study reported that multiple-times balloon inflation at the same pressure resulted in better stent expansion compared to one-time balloon inflation. In our facility, we frequently perform the repeated 3-time-balloon-inflation method, wherein the stent delivery balloon was inflated 3 times at nominal pressure to deploy the stent, to improve stent expansion without high-pressure balloon inflation. Although this method seems effective in avoiding excessive high-pressure dilation, its clinical data are insufficient. In this study, we investigated the clinical outcomes of the repeated 3-time-balloon-inflation method. This retrospective study included 370 patients with 467 stented coronary lesions. These subjects were divided into two groups: one with standard balloon inflation and the other with repeated 3-time balloon inflation, and treatment outcomes were compared. The repeated 3-time-balloon-inflation group had 254 lesions, and the standard-balloon-inflation group had 213 lesions. Stent edge dissection occurred in 6 lesions (2.8%) in the standard-balloon-inflation group, whereas did not occur in the repeated 3-time-balloon-inflation group. A statistically significant difference remained even after propensity score matching (p = 0.040). The final minimum stent area and long-term clinical outcomes were not significantly different between the two groups. The repeated 3-time-balloon-inflation method may reduce stent edge dissection while demonstrating comparable minimal stent area and long-term outcomes to the standard-balloon-inflation method.
冠状动脉支架置入的最佳操作方案仍未确定。常采用高压球囊后扩张来优化支架扩张。然而，高压扩张也存在冠状动脉损伤的潜在风险。先前的一项体外研究报告称，与一次性球囊充气相比，在相同压力下多次球囊充气可使支架扩张效果更好。在我们的机构中，我们经常采用重复三次球囊充气法，即在标称压力下将支架输送球囊充气三次以置入支架，从而在不进行高压球囊充气的情况下改善支架扩张。尽管这种方法似乎能有效避免过度高压扩张，但其临床数据并不充分。在本研究中，我们调查了重复三次球囊充气法的临床疗效。这项回顾性研究纳入了370例患者的467处冠状动脉支架置入病变。这些受试者被分为两组：一组采用标准球囊充气，另一组采用重复三次球囊充气，然后比较治疗效果。重复三次球囊充气组有254处病变，标准球囊充气组有213处病变。标准球囊充气组有6处病变（2.8%）发生支架边缘夹层，而重复三次球囊充气组未发生。即使在倾向评分匹配后，仍存在统计学显著差异（p = 0.040）。两组之间最终的最小支架面积和长期临床疗效无显著差异。重复三次球囊充气法可能会减少支架边缘夹层，同时显示出与标准球囊充气法相当的最小支架面积和长期疗效。
