The impact of final kissing balloon inflation on anatomical structure in single-stent technique strategy for left-main bifurcation lesion: a serial IVUS study
Lin Qingcheng, Zhu Qianli, Huang Weijian, Shan#br# Peiren
Department of Cardiology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou325015, China
Lin Qingcheng,Zhu Qianli,Huang Weijian, et al. The impact of final kissing balloon inflation on anatomical structure in single-stent technique strategy for left-main bifurcation lesion: a serial IVUS study[J]. JOURNAL OF WEZHOU MEDICAL UNIVERSITY, 2021, 51(10): 793-799.
Abstract：Objective: To investigate the impact of final kissing balloon inflation (FKBI) on anatomical structure in single-stent crossover technique for left main artery bifurcation lesions with serial intravascular ultrasound (IVUS) imaging. Methods: Totally, 36 patients with left main artery bifurcation lesions were prospectively enrolled,and treated with single-stent crossover strategy. Serial IVUS pullback examinations were performed, including the runs of pre-intervention from both left anterior descending artery (LAD, run1) and left circumflex artery (LCX, run2), the run of post-stenting from LAD (run3), and the runs of post-FKBI from both LAD (run4) and LCX (run5). Results: The mean age of these patients was (63.8±12.1) years old, with left main true bifurcation lesion accounting for 22.2%. Compared with IVUS imaging of pre-intervention (run2), the ostium area of LCX was significantly decreased after FKBI [run5, (7.30±3.08)mm2 vs. (6.37±2.66)mm2, P<0.001], as well as vessel area [(13.10±3.27)mm2 vs. (12.47±2.93)mm2, P=0.012], however, there was no significant changes in plaque area [(5.80±2.02)mm2 vs. (6.10±2.09)mm2, P=0.128]. The change in lumen area within the LCX ostium was positivelycorrelated with the change in EEM area (r=0.787, P<0.05), but not with plaque area (r=0.187, P=0.276). Compared with IVUS imaging of post-stenting (run3), FKBI (run4) significantly increased the area at the site of polygon of confluence [POC, (9.80±2.09)mm2 vs. (11.48±2.65)mm2, P<0.05], distal left main [(9.91±1.73)mm2 vs. (11.85±2.38)mm2, P<0.05] and the minimal lumen area (MLA) of the left main [(9.61±1.53)mm2 vs. (11.34±2.33)mm2,P<0.05], decreased stent malapposition phenomena (83.3% vs. 61.1%, P=0.035), but increased the stent asymmetry index significantly (POC: 1.23±0.14 vs. 1.33±0.12, P<0.05; Distal LM: 1.18±0.09 vs. 1.25±0.10, P<0.05; MLA:1.17±0.09 vs. 1.24±0.10, P<0.05). Conclusion: Our analysis showed that carina shift, instead of plaque shift, was the main mechanism of LCX ostium compromise after FKBI in single-stent crossover technique for left-main bifurcation lesions. FKBI increased the stent area of the left main and POC, and decreased stent malapposition phenomena, at the cost of increasing stent symmetric index.
