GW29-e1902 Branch Ostial Optimization Treatment and Optimized Provisional T-Stenting with Polymeric Bioresorbable Scaffolds: Ex Vivo Morphologic and Hemodynamic Examination
GW29-e1902 Branch Ostial Optimization Treatment and Optimized Provisional T-Stenting with Polymeric Bioresorbable Scaffolds: Ex Vivo Morphologic and Hemodynamic Examination
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GW29-e1902 分支口优化治疗和使用聚合物生物可吸收支架优化临时 T 形支架：离体形态和血流动力学检查
DOI：
10.1016/j.jacc.2018.08.470
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发表时间：
2018-10
影响因子：
24
通讯作者：
Lianglong Chen
中科院分区：
文献类型：
--
作者：
Wei Cai;Lianglong Chen
目的在生物可吸收血管支架（BVS）时代，临时侧支支架后的最佳侧支口治疗仍然是一个争论的主题。在这项研究中，我们评估了一种新的优化临时T-支架技术（OPT），并通过与T和小突起技术（TAP）的比较来评估其可行性。方法采用两种临时SB支架技术（OPT, n= 5； TAP, n= 5），采用聚合物BVS在分岔幻影中进行。连续的中间依偎球囊扩张，也称为口优化技术，被添加到OPT中以扩张侧支口，但未添加到TAP中，最终依偎球囊扩张用于两个程序。采用显微计算机断层扫描（microCT）和光学相干断层扫描（OCT）评估形态学，并采用计算流体动力学（CFD）评估支架分岔中的血流动力学。结果微ct分析显示，与TAP相比，OPT的新隆突长度较短（0.34±0.10 mm比1.02±0.26 mm， P< 0.01），外翻支长度较长（2.49±0.27 mm比1.78±0.33 mm， P< 0.01）， MB口面积较大（9.46±0.04 mm2比8.34±0.09 mm2， P< 0.01）；OCT结果显示，OPT可显著降低支杆偏倚（13.20±0.16% vs. 1.94±0.54%，P< 0.01）。CFD结果显示，相比TAP， OPT产生了更有利的流态，侧壁低剪应力（< 0.4 Pa）所占比例（4.68±1.40% vs 8.88±1.21%，P< 0.01）更低。结论采用BVSs进行分岔干预，序贯式中间依偎球囊扩张可优化鼻窦炎，促进后续鼻窦炎支架的搭建。结果显示，OPT在分叉形态和血流动力学方面优于TAP。
ObjectivesThe optimal side-branch 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).MethodsTwo provisional SB scaffolding techniques (OPT, n= 5; TAP, n= 5) were performed in a bifurcated phantom using polymeric BVS. The sequential intermediate snuggling balloon dilation, also called ostial optimal technique, was added to OPT to dilate the side-branch ostium, but it was not added to TAP, with the final snuggling balloon dilation used for both procedures. Micro-computed 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.ResultsCompared to TAP, microCT analysis showed that OPT created shorter neo-carina length (0.34±0.10 mm vs. 1.02±0.26 mm, P< 0.01), longer valgus struts length (2.49±0.27 mm vs. 1.78±0.33 mm, P< 0.01) with larger MB ostial area (9.46±0.04 mm2 vs. 8.34±0.09 mm2, P< 0.01); OCT found that OPT significantly decreased the struts mal-apposition (13.20±0.16% vs. 1.94±0.54%, P< 0.01). CFD revealed that OPT generated more favorable flow pattern than that of TAP, as indicated by less percent (4.68±1.40% vs. 8.88±1.21%, P< 0.01) of low wall shear stress (< 0.4 Pa) along the lateral walls.ConclusionsUsing BVSs for bifurcation intervention, the sequential intermediate snuggling balloon dilation is feasible for optimizing ostial SB and facilitating subsequent SB scaffolding. Results showed OPT to be better than TAP for bifurcated morphology and hemodynamics.