改良的气囊支架接吻技术避免了单纯的真正的分叉病变的侧支折衷。,BMC Cardiovascular Disorders

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改良的气囊支架接吻技术避免了单纯的真正的分叉病变的侧支折衷。
BMC Cardiovascular Disorders ( IF 2.0 ) Pub Date : 2019-04-08 , DOI: 10.1186/s12872-019-1052-0
Wen-Bo Qu ₁ , Wei Zhang ₁ , Jun-Yan Liu ₁ , Fan Zhang ₁ , Shuai-Nan Mu ₁ , Sheng-Ming Zhang ₁ , Hao Tang ₁ , Xi-Qian Liu ₁ , Xue-Qi Li ₁ , Bing-Chen Liu ₁

Affiliation

背景技术冠状动脉分叉术仍然是介入心脏病学中最具挑战性的病变亚组之一。临时性支架置入术（PS）是分叉病变的主要技术，但关键问题是侧支的恶化。气球支架接吻技术（BSKT）是一种新的系统方法，它基于改进的监狱气球技术，提高了手术的成功率。在我们中心，我们提出了一种改进的气囊支架接吻技术（M-BSKT），该技术将重新布线后的近端优化技术（POT）的常规用法添加为BSKT的优化步骤。因此，用于解决简单的真正的冠状动脉分叉病变的M-BSKT是否可以在术中效果和长期预后方面提供更多益处仍然未知。方法该回顾性单中心研究纳入了120例连续的行经皮冠状动脉介入治疗（PCI）且单纯的真正的冠状动脉分叉病变符合标准的患者。为了组建具有相似基线特征的队列，使用了1：1倾向匹配得分。主要结果是器械和手术成功率，主血管（MV）充气后侧支（SB）的情况以及术中并发症。次要结果是12个月的临床预后，例如因不稳定型心绞痛和MACE再次住院。结果在倾向匹配之前，两组之间的主要和次要结局没有显着差异。使用倾向匹配后，纳入了68个倾向评分相似的患者。在即刻手术中，M-BSKT与SB恶化的风险较低，并且使用最终接吻球囊充气（FKBI）相关[P = 0.036]。对于ACS患者，除了立即SB恶化[P = 0.014]和应用FKBI [P = 0.033]的显着差异外，PS中TIMI流<3的发生率在统计学上显着高于M-BSKT [P = 0.042]。两组在12个月时的预后如不稳定型心绞痛和MACE的再入院相似[P = 0.613]。结论这些观察结果证明，M-BSKT能够在简单的真正的分叉病变中以较小的幅度更好地保护侧支。与PS相比，它可以改善有关侧支恶化和最终接吻球囊表现的血管造影结果，尤其是ACS患者。然而，

"点击查看英文标题和摘要"

Modified balloon-stent kissing technique avoid side-branch compromise for simple true bifurcation lesions.

BACKGROUND Coronary bifurcation remains one of the most challenging lesion subsets in interventinal cardiology. Provisional stenting (PS) is the dominate technique for bifurcation lesions, but the key problem is the deterioration of side branch. Balloon-stent kissing technique (BSKT) as a new systematic approach which is based on modified jailed balloon technique is applied to improve the procedure success. In our center, we proposed a modified balloon-stent kissing technique(M-BSKT), which routine usage of proximal optimizing technique (POT) after rewiring was added as an optimization step to BSKT. Thus, whether M-BSKT for addressing simple true coronary bifurcation lesions can provide more benefits in intra-operation effect and long term outcomes is still unknown. METHODS A cohort of 120 consecutive patients underwent Percutaneous Coronary Intervention (PCI) with simple true coronary bifurcation lesions satisfied the criteria were included in this retrospective, single-center registry. To assemble a cohort with similar baseline characteristics, a 1:1 propensity-matched score was used. The primary outcomes were the rate of device and procedural success, the situation of side branch (SB) after main vessel (MV) inflation and the complications during intra-operative. The secondary outcomes were the clinical prognosis at 12 months such as rehospitalization for unstable angina and MACEs. RESULTS Before propensity matching, there were no significant differences in primary and secondary outcomes between two groups. After propensity-matched was used, 68 patients with similar propensity scores were included. At immediate procedural, M-BSKT was associated with a lower risk of SB deterioration and the application of final kissing balloon inflation (FKBI)[P = 0.036]. For ACS patients, besides the significant differences of immediate SB deterioration [P = 0.014] and FKBI application [P = 0.033], the incidence of TIMI flow< 3 in the PS was statistically significant higher than M-BSKT [P= 0.042]. The prognosis at 12 months such as rehospitalization for unstable angina and MACEs were similar for two groups [P = 0.613]. CONCLUSION These observations prove that the M-BSKT enables side branch to be better protected in simple true bifurcation lesions, by a narrow margin. It may improve the angiographic outcomes about side branch deterioration and final kissing balloon performing compared with PS, especially in ACS patients. However, long-term clinical outcomes did not differ between patients treated for M-BSKT and PS at 12 months.

更新日期：2019-04-08

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