先期近端优化技术改善分叉病变双支架术的预后
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摘要
目的探讨先期近端优化技术(POT)能否常规应用于各种分叉病变双支架术。方法选择我院近3年接受双支架治疗的分叉病变患者386例,根据是否采用先期POT,分为先期POT组178例[先期POT结合常规对吻球囊扩张(KBI)]和KBI组208例。观察2组1年不良心血管事件、KBI成功率及效率。结果在随访期内,先期POT组不良心血管事件发生率(11.2%vs 19.7%,P=0.03)和再次靶血管重建率低于KBI组(7.3%vs 13.9%,P=0.04),KBI成功率明显高于KBI组(98.3%vs 88.5%,P=0.00)。结论先期POT结合KBI,能提高KBI成功率及操作效率,使双支架术治疗分叉病变获得更佳临床预后。
Objective To study the application of preproximal optimization technique(pre-POT)in treatment of bifurcate lesions after implantation of two stents.Methods Three hundred and eighty-six bifurcation lesions patients who underwent implantation of two stents in our hospital were divided into pre-POT group(n=178)and kiss balloon inflation(KBI)group(n=208).The 1-year incidence of MACE,the success rate and efficiency of KBI were retrospectively analyzed.Results The incidence of MACE was significantly lower in pre-POT group than in KBI group during the follow-up period(11.2%vs 19.7%,P=0.03).The revascularization rate of target lesions was significantly lower while the success rate was significantly higher in pre-POT group than in KBI group(7.3%vs 13.9%,P=0.04;98.3%vs 88.5%,P=0.00).Conclusion pre-POT combined with KBI seems to improve the success rate and efficiency of KBI and achieve the better outcome of bifurcate lesions after implantation of two stents.
Objective To study the application of preproximal optimization technique(pre-POT)in treatment of bifurcate lesions after implantation of two stents.Methods Three hundred and eighty-six bifurcation lesions patients who underwent implantation of two stents in our hospital were divided into pre-POT group(n=178)and kiss balloon inflation(KBI)group(n=208).The 1-year incidence of MACE,the success rate and efficiency of KBI were retrospectively analyzed.Results The incidence of MACE was significantly lower in pre-POT group than in KBI group during the follow-up period(11.2%vs 19.7%,P=0.03).The revascularization rate of target lesions was significantly lower while the success rate was significantly higher in pre-POT group than in KBI group(7.3%vs 13.9%,P=0.04;98.3%vs 88.5%,P=0.00).Conclusion pre-POT combined with KBI seems to improve the success rate and efficiency of KBI and achieve the better outcome of bifurcate lesions after implantation of two stents.
引文
[1]Colombo A,Jabbour RJ.Bifurcation lesions:no need to implant two stents when one is sufficient[J]!Eur Heart J,2016,37(24):1929-1931.DOI:10.1093/eurheartj/eh w185.
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[4]Finet G,Derimay F,Motreff P,et al.Comparative analysis of sequential proximal optimizing technique versus kissing balloon inflation technique in provisional bifurcation stenting:fractal coronary bifurcation bench test[J].JACC Cardiovasc Interv,2015,8(10):1308-1317.DOI:10.1016/j.jcin.2015.05.016.
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[7]Mortier P,Hikichi Y,FoinN,et al.Provisional stenting of coronary bifurcations:insights into final kissing balloon post-dilation and stent design by computational modeling[J].JACCCardiovasc Interv,2014,7(3):325-333.DOI:10.1016/j.jcin.2013.09.012.
[8]Foin N,Secco GG,Ghilencea L,et al.Final proximal postdilatation is necessary after kissing balloon in bifurcation stenting[J].EuroIntervention,2011,7(5):597-604.DOI:10.4244/EIJV7I5A96.
[9]Foin N,Torii R,Mortier P,et al.Kissing balloon or sequential dilation of the side branch and main vessel for provisional stenting of bifurcations:lessons from micro-computed tomography and computational simulations[J].JACC Cardiovasc Interv,2012,5(1):47-56.DOI:10.1016/j.jcin.2011.08.019.
[10]Dérimay F,Finet G,Souteyrand G,et al.Benefit of a new provisional stenting strategy,the re-proximal optimisation technique:the rePOT clinical study[J].EuroIntervention,2018,14(3):e325-e332.DOI:10.4244/EIJ-D-17-00941.
[11]Grundeken MJ,Collet C,Ishibashi Y,et al.Visual estimation versus different quantitative coronary angiography methods to assess lesion severity in bifurcation lesions[J].Catheter Cardiovasc Interv,2018,91(7):1263-1270.DOI:10.1002/ccd.27243.
[12]Hildick-Smith D,de Belder AJ,Cooter N,et al.Randomized trial of simple versus complex drug-eluting stenting for bifurcation lesions:the British Bifurcation Coronary Study:old,new,and evolving strategies[J].Circulation,2010,121(10):1235-1243.DOI:10.1161/CIRCULATIONAHA.109.888297.
[13]Würtz M,Christiansen EH,Kristensen SD,et al.Accidentally crushed stent during complex bifurcation treatment.A potential cause of very late stent thrombosis[J].Int J Cardiol,2015,197:113-115.DOI:10.1016/j.ijcard.2015.06.045.
[14]Rigatelli G,Zuin M,Dell'Awocata F,et al.Evaluation of coronary flow conditions in complex coronary artery bifurcations stenting using computational fluid dynamics:impact of final proximal optimization technique on different double-stent techniques[J].Cardiovasc Revasc Med,2017,18(4):233-240.DOI:10.1016/j.carrev.2017.01.002.
[2]Lassen JF,Burzotta F,Banning AP,et al.Percutaneous coronary intervention for the left main stem and other bifurcation lesions:12th consensus document from the European Bifurcation Club[J].EuroIntervention,2018,13(13):1540-1553.DOI:10.4244/EIJ-D-17-00622.
[3]Sgueglia GA,Chevalier B.Kissing balloon inflation in percutaneous coronary interventions[J].JACC Cardiovasc Interv,2012,5(8):803-811.DOI:10.1016/j.jcin.2012.06.005.
[4]Finet G,Derimay F,Motreff P,et al.Comparative analysis of sequential proximal optimizing technique versus kissing balloon inflation technique in provisional bifurcation stenting:fractal coronary bifurcation bench test[J].JACC Cardiovasc Interv,2015,8(10):1308-1317.DOI:10.1016/j.jcin.2015.05.016.
[5]Gwon HC,Hahn JY,Koo BK,et al.Final kissing ballooning and long-term clinical outcomes in coronary bifurcation lesions treated with 1-stent technique:results from the COBISRegistry[J].Heart,2012,98(3):225-231.DOI:10.1136/heartjnl-2011-300322.
[6]Murasato Y,Iwasaki K,Yamamoto T,et al.Optimal kissing balloon inflation after single-stent deployment in a coronary bifurcation model[J].EuroIntervention,2014,10(8):934-941.DOI:10.4244/EIJV10I8A160.
[7]Mortier P,Hikichi Y,FoinN,et al.Provisional stenting of coronary bifurcations:insights into final kissing balloon post-dilation and stent design by computational modeling[J].JACCCardiovasc Interv,2014,7(3):325-333.DOI:10.1016/j.jcin.2013.09.012.
[8]Foin N,Secco GG,Ghilencea L,et al.Final proximal postdilatation is necessary after kissing balloon in bifurcation stenting[J].EuroIntervention,2011,7(5):597-604.DOI:10.4244/EIJV7I5A96.
[9]Foin N,Torii R,Mortier P,et al.Kissing balloon or sequential dilation of the side branch and main vessel for provisional stenting of bifurcations:lessons from micro-computed tomography and computational simulations[J].JACC Cardiovasc Interv,2012,5(1):47-56.DOI:10.1016/j.jcin.2011.08.019.
[10]Dérimay F,Finet G,Souteyrand G,et al.Benefit of a new provisional stenting strategy,the re-proximal optimisation technique:the rePOT clinical study[J].EuroIntervention,2018,14(3):e325-e332.DOI:10.4244/EIJ-D-17-00941.
[11]Grundeken MJ,Collet C,Ishibashi Y,et al.Visual estimation versus different quantitative coronary angiography methods to assess lesion severity in bifurcation lesions[J].Catheter Cardiovasc Interv,2018,91(7):1263-1270.DOI:10.1002/ccd.27243.
[12]Hildick-Smith D,de Belder AJ,Cooter N,et al.Randomized trial of simple versus complex drug-eluting stenting for bifurcation lesions:the British Bifurcation Coronary Study:old,new,and evolving strategies[J].Circulation,2010,121(10):1235-1243.DOI:10.1161/CIRCULATIONAHA.109.888297.
[13]Würtz M,Christiansen EH,Kristensen SD,et al.Accidentally crushed stent during complex bifurcation treatment.A potential cause of very late stent thrombosis[J].Int J Cardiol,2015,197:113-115.DOI:10.1016/j.ijcard.2015.06.045.
[14]Rigatelli G,Zuin M,Dell'Awocata F,et al.Evaluation of coronary flow conditions in complex coronary artery bifurcations stenting using computational fluid dynamics:impact of final proximal optimization technique on different double-stent techniques[J].Cardiovasc Revasc Med,2017,18(4):233-240.DOI:10.1016/j.carrev.2017.01.002.