Comparative Analysis of Sequential Proximal Optimizing Technique Versus Kissing Balloon Inflation Technique in Provisional Bifurcation Stenting Fractal Coronary Bifurcation Bench Test
Comparative Analysis of Sequential Proximal Optimizing Technique Versus Kissing Balloon Inflation Technique in Provisional Bifurcation Stenting Fractal Coronary Bifurcation Bench Test
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DOI：
10.1016/j.jcin.2015.05.016
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发表时间：
2015-08-24
影响因子：
11.3
通讯作者：
Rioufol, Gilles
中科院分区：
文献类型：
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作者：
Finet, Gerard;Derimay, Francois;Rioufol, Gilles
本研究使用分形分叉实验室模型比较了冠状动脉分叉临时支架植入术的6种优化序列，包括1种无对吻球囊充盈（KBI）的新型序列，包括初始近端优化技术（POT）+侧支充盈（SBI）+最终POT，称为“重新POT”。在临时分叉支架植入术中，KBI未能改善主要不良心脏事件的发生率。方法采用分叉实验台模型比较单纯KBI、POT后KBI、POT后KBI+非对称充盈压力、初始POT + SBI、初始POT + SBI+最终POT（简称“re-POT”）3种无KBI的治疗方法。结果与经典的单纯KBI序列和POT+改良KBI序列相比，re-POT序列在支架植入后的平均植入时间、平均植入（p < 0.05）更好的几何结果：其将SB开口支架-支柱阻塞从23.2 +/- 6.0%降低至5.6 +/-8.3%，提供了完美的近端支架贴壁，具有几乎完美的圆形（椭圆度指数从1.23 +/-0.02降至1.04 +/-0.01），近端区域过度拉伸从24.2 +/-7.6%降至8.0 +/-0.4%，并且将整体支柱贴壁不良从40 +/- 6.2%降低到2.6 +/-1.4%。结论与其他5种技术相比，re-POT序列显著优化了临时冠状动脉分叉支架植入术的最终结果，保持圆形几何结构，同时显著减少SB开口支柱阻塞和整体支柱贴壁不良。这些实验结果证实，使用re-POT可以在不使用KBI的情况下更有效地优化临时支架植入术。(C)2015年由美国心脏病学会基金会。
OBJECTIVES This study used a fractal bifurcation bench model to compare 6 optimization sequences for coronary bifurcation provisional stenting, including 1 novel sequence without kissing balloon inflation (KBI), comprising initial proximal optimizing technique (POT) + side-branch inflation (SBI) + final POT, called "re-POT."BACKGROUND In provisional bifurcation stenting, KBI fails to improve the rate of major adverse cardiac events. Proximal geometric deformation increases the rate of in-stent restenosis and target lesion revascularization.METHODS A bifurcation bench model was used to compare KBI alone, KBI after POT, KBI with asymmetric inflation pressure after POT, and 2 sequences without KBI: initial POT plus SBI, and initial POT plus SBI with final POT (called "re-POT"). For each protocol, 5 stents were tested using 2 different drug-eluting stent designs: that is, a total of 60 tests.RESULTS Compared with the classic KBI-only sequence and those associating POT with modified KBI, the re-POT sequence gave significantly (p < 0.05) better geometric results: it reduced SB ostium stent-strut obstruction from 23.2 +/- 6.0% to 5.6 +/- 8.3%, provided perfect proximal stent apposition with almost perfect circularity (ellipticity index reduced from 1.23 +/- 0.02 to 1.04 +/- 0.01), reduced proximal area overstretch from 24.2 +/- 7.6% to 8.0 +/- 0.4%, and reduced global strut malapposition from 40 +/- 6.2% to 2.6 +/- 1.4%.CONCLUSIONS In comparison with 5 other techniques, the re-POT sequence significantly optimized the final result of provisional coronary bifurcation stenting, maintaining circular geometry while significantly reducing SB ostium strut obstruction and global strut malapposition. These experimental findings confirm that provisional stenting may be optimized more effectively without KBI using re-POT. (C) 2015 by the American College of Cardiology Foundation.