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| 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 |
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| Cite this article: |
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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.
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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.
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Received: 19 April 2021
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