Examination of Stent Deformation and Gap Formation after Complex Stenting of Left Main Coronary Artery Bifurcations Using Microfocus Computed Tomography
Examination of Stent Deformation and Gap Formation after Complex Stenting of Left Main Coronary Artery Bifurcations Using Microfocus Computed Tomography
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DOI：
10.1111/j.1540-8183.2009.00436.x
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发表时间：
2009-04-01
影响因子：
2.1
通讯作者：
Horiuchi, Masataka
中科院分区：
文献类型：
--
作者：
Murasato, Yoshinobu;Hikichi, Yutaka;Horiuchi, Masataka
背景资料：目的：采用微焦点CT（MFCT）对不同支架置入术后左主干分叉模型的支架置入效果进行研究。在三维（3D）LM模型上进行了经典挤压、双对吻（DK）-双挤压和支架植入术。使用横截面，纵向和三维重建视图MFCT.Results的结果进行了评估：观察到不均匀的支柱分布在一个直的血管段上部署的波纹支架设计。在经典挤压支架植入术后，在波纹支架中观察到非心肌部位的相对较大的间隙。当导丝在挤压的侧分支支架的开口外再次交叉时，对吻球囊充盈导致支架在更远段进一步挤压。在DK挤压支架植入术中，在第一次对吻球囊充盈后，扩张的支柱从主血管床升起;在主血管支架植入术后，由于重新挤压升起的支柱，DK的优势将被取消。当用3.5 mm球囊扩张时，闭孔支架的扩张在分支开口处受到限制。结论：三维体模模型中的MFCT分析有助于评价LM分叉处复杂支架植入后支架的结构变形和支架间隙对血管壁的覆盖情况。（J Interven Cardiol 2009;22：135-144）。
Background: Fluoroscopy and intravascular ultrasound (IVUS) lack sufficient resolution for assessing the results of complex stenting in true bifurcation lesions.Objectives: After diverse bifurcation stenting at the left main coronary artery (LM) bifurcation model, the results were examined using microfocus computed tomography (MFCT).Methods: The strut distribution of three kinds of stents deployed on a straight vessel segment was investigated. Classical crush, double kissing (DK)-double crush, and culotte stenting were performed on a three-dimensional (3D) LM model. The results were assessed using cross-sectional, longitudinal, and 3D reconstruction views of MFCT.Results: Nonuniform strut distribution was observed in a corrugated stent design deployed on a straight vessel segment. Following classical crush stenting, a relatively large gap at the nonmyocardial site was observed in the corrugated stents. When the guidewire recrossed outside the ostium of the crushed side branch stent, kissing balloon inflation caused further crushing of the stent at the more distal segment. The dilated strut rose up from the main vessel bed after the first kissing balloon inflation in DK crush stenting; the advantage of DK would be cancelled after main vessel stenting due to recrushing the raised strut. The culotte stenting with closed-cell stents showed the restriction of the expansion at the branch ostium when it was dilated with a 3.5-mm balloon. The culotte stenting with open-cell-based stents showed a good stent apposition except for a tiny gap and small metallic carina at the distal bifurcation.Conclusion: MFCT analysis in the 3D phantom model is useful to assess the structural deformation of the stents and gap on vessel wall coverage after complex stenting at the LM bifurcation.(J Interven Cardiol 2009;22:135-144).