Branch ostial optimization treatment and optimized provisional t-stenting with polymeric bioresorbable scaffolds: Ex-vivo morphologic and hemodynamic examination.
Branch ostial optimization treatment and optimized provisional t-stenting with polymeric bioresorbable scaffolds: Ex-vivo morphologic and hemodynamic examination.
复制标题
使用聚合物生物可吸收支架进行分支口优化治疗和优化临时 T 型支架置入
DOI：
10.1097/md.0000000000012972
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发表时间：
2018-10
期刊：
影响因子：
1.6
通讯作者：
Zheng X
中科院分区：
文献类型：
--
作者：
Cai W;Chen L;Zhang L;Tu S;Fan L;Chen Z;Luo Y;Zheng X
摘要 在生物可吸收血管支架（BVS）时代，临时侧支支架后最佳的侧支（SB）口治疗仍然是一个争论的话题。在本研究中，我们评估了一种新型优化临时 T 型支架技术 (OPT)，并通过与 T 型支架技术和小突出技术 (TAP) 进行比较来评估其可行性。在分叉模型中使用聚合物 BVS 进行了两种临时 SB 支架技术（OPT，n = 5；TAP，n = 5）。顺序中间依偎球囊扩张（也称为孔口最佳技术）被添加到 OPT 而不是 TAP 中，以扩张侧枝口，而最终依偎球囊扩张适用于这两种手术。进行微计算机断层扫描（microCT）和光学相干断层扫描（OCT）来评估形态学，并进行计算流体动力学（CFD）来评估支架分叉处的血流动力学。在 microCT 分析中与 TAP 相比，OPT 产生的新隆突长度比 TAP 短（0.34 ± 0.10 mm 比 1.02 ± 0.26 mm，P < .01），外翻支柱长度更长（2.49 ± 0.27 mm 比1.78 ± 0.33 mm，P < .01），MB孔口面积更大（9.46 ± 0.04 mm2 vs 8.34 ± 0.09 mm2，P < .01）。 OCT发现OPT显着减少了支柱的错位（13.20±0.16% vs 1.94±0.54%，P< .01）。 CFD 显示，OPT 比 TAP 产生更有利的流动模式，沿侧壁的低壁剪应力 (<0.4Pa) 的百分比较小 (4.68±1.40% vs 8.88±1.21%, P < .01)。通过使用 BVS 进行分叉干预，顺序中间依偎球囊扩张对于优化 SB 口并促进后续 SB 支架是可行的。结果表明，在这项离体研究中，OPT 的分叉形态和血流动力学优于 TAP。
Abstract The optimal side-branch (SB) ostium treatment after provisional side-branch scaffolding remains a subject of debate in bioresorbable vascular scaffold (BVS) era. In this study, we evaluated a novel optimized provisional T-stenting technique (OPT) and assessed its feasibility by comparison with T and small protrusion technique (TAP). Two provisional SB scaffolding techniques (OPT, n = 5; TAP, n = 5) were performed using polymeric BVS in a bifurcated phantom. The sequential intermediate snuggling balloon dilation, also called ostial optimal technique, was added to OPT but not TAP to dilate the side-branch ostium while the final snuggling balloon dilation applied for both procedures. Microcomputed tomography (microCT) and optical coherence tomography (OCT) were performed to assess morphology, and computational fluid dynamics (CFD) was performed to assess hemodynamics in the scaffolded bifurcations. Compared with TAP in microCT analysis, OPT created shorter neo-carina length than TAP (0.34 ± 0.10 mm vs 1.02 ± 0.26 mm, P < .01), longer valgus struts length (2.49 ± 0.27 mm vs 1.78 ± 0.33 mm, P < .01) with larger MB ostial area (9.46 ± 0.04 mm2 vs 8.34 ± 0.09 mm2, P < .01). OCT found that OPT significantly decreased the struts mal-apposition (13.20 ± 0.16% vs 1.94 ± 0.54%, P < .01). CFD revealed that OPT generated more favorable flow pattern than TAP, as indicated by less percent (4.68 ± 1.40% vs 8.88 ± 1.21%, P < .01) of low wall shear stress (<0.4 Pa) along the lateral walls. By using BVSs for bifurcation intervention, the sequential intermediate snuggling balloon dilation is feasible for optimizing ostial SB and facilitating subsequent SB scaffolding. Results show OPT is better than TAP for bifurcated morphology and hemodynamics in this ex-vivo study.