Structural Damage of Jailed Guidewire During the Treatment of Coronary Bifurcation Lesions: A Microscopic Randomized Trial

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• 作者：Manuel Pan ; MD ; ^{manuelpanalvarez@gmail.com" class="auth_mail" title="E-mail the corresponding author} ; Soledad Ojeda ; MD ; Elena Villanueva ; MD ; Jorge Chavarria ; MD ; Miguel Romero ; MD ; Javier Suarez de Lezo ; MD ; Francisco Mazuelos ; MD ; Jose Segura ; MD ; Francisco Carrasco ; MD ; Francisco Hidalgo ; MD ; Jose Lopez Aguilera ; MD ; Sara Rodriguez ; MD ; Miguel Puente ; MD ; Jose Suarez de Lezo ; MD
• 关键词：bifurcation lesions ; jailed wire technique ; provisional stenting
• 刊名：JACC: Cardiovascular Interventions
• 出版年：2016
• 出版时间：26 September 2016
• 年：2016
• 卷：9
• 期：18
• 页码：1917-1924
• 全文大小：1212 K

文摘

The study sought to compare the safety (resistance to damage) and efficacy (ability to cross the side branch) of polymer-coated and non–polymer-coated guidewires in the jailed wire technique used during the percutaneous treatment of bifurcation lesions.

Background

The jailed wire technique is a useful strategy in the treatment of bifurcation lesions by provisional stenting. However, these wires can be damaged or even be broken during their removal.

Methods

We performed a randomized study in patients with bifurcation lesions treated by provisional stenting. The jailed wire technique was mandatory, and the types of guidewires, polymer-coated (n = 115) and non–polymer-coated (n = 120), were randomized. After the procedures, the wires were evaluated by stereoscopic microscopy. The induced damage in the wires was classified as follows: no damage, mild, moderate, or severe.

Results

The clinical characteristics were similar between patients treated with polymer-coated or non–polymer-coated wires. Polymer-coated wires were significantly (p < 0.001) more resistant to retrieval damage (only 2 wires showed mild damage) than were non–polymer-coated wires. However, 63 (55%) of the non–polymer-coated wires were damaged; 37 (32%), 24 (21%), and 2 (2%) had mild, moderate, and severe damage, respectively. Additionally, the jailed length of the wire was a factor contributing to the degree of wire damage. The time of side branch wiring was shorter in the polymer-coated wire group (19 ± 40 s vs. 42 ± 72 s; p < 0.05).

Conclusions

Jailed wires during interventional procedures of bifurcation lesions commonly showed microscopic damage. Polymer-coated wires were more resistant to retrieval damage and were more efficient in crossing the side branch ostium than non–polymer-coated wires. (Jailed Wire Technique in the Treatment of Coronary Bifurcations Lesions With Stent: Stereoscopic Microscopy Study; NCT02516891)