3D-OCT验证拘禁球囊技术对分支开口的保护作用

Protection of side-branch ostium by the jailed balloon technique validated by three-dimensional optical coherence tomography

目的应用三维光学相干断层成像(OCT)验证拘禁球囊技术对分支开口的保护作用。方法本研究为回顾性研究。连续入选2019年9月至2022年3月在解放军总医院行经皮冠状动脉介入治疗并分别于手术前后完成OCT检查的冠状动脉分叉病变患者。根据所采用的分支保护策略将患者分为拘禁球囊组和未保护组。通过OCT图像计算患者的分支开口面积差(分支开口面积差=术后分支开口面积-术前分支开口面积)。比较两组的分支开口面积差,并在真性分叉病变和非真性分叉病变亚组中再次比较。在拘禁球囊组中,分别比较使用主动拘禁球囊技术和传统拘禁球囊技术者、使用直径>2.0 mm拘禁球囊和≤2.0 mm拘禁球囊者、给予较大球囊压力(>4 atm,1 atm=101.325 kPa)和较小的球囊压力(≤4 atm)者的分支开口面积。采用多因素线性回归分析探索拘禁球囊技术参数与分支保护作用的相关性。结果共入选176例患者,共含有236个分叉病变,年龄(60.7±9.3)岁,其中男性128例(72.7%)。拘禁球囊组67例患者包含71例分叉病变,未保护组123患者包含165例分叉病变(14例患者存在2~3处分叉病变,分别采用不同处理方式,故同时出现在了未保护组和拘禁球囊组)。拘禁球囊组分支开口面积差大于未保护组[0.07(-0.43,1.05)mm2比-0.33(-0.83,0.26)mm2,P<0.001],在真性分叉病变亚组中结果与之一致[0.29(-0.35,0.96)mm2比-0.26(-0.64,0.29)mm2,P=0.004],而非真性分叉病变亚组中两组差异无统计学意义(P=0.136)。在拘禁球囊组中,使用主动拘禁球囊技术患者的分支开口面积差大于使用传统拘禁球囊技术者[(0.43±1.36)mm2比(-0.22±0.52)mm2,P=0.013]。使用直径>2.0 mm拘禁球囊者的分支开口面积差大于使用直径≤2.0 mm拘禁球囊者[0.25(-0.51,1.31)mm2比-0.01(-0.45,0.63)mm2,P=0.020],而给予较大球囊压力和较小球囊压力者比较,分支开口面积差的差异无统计学意义(P=0.731)。多因素线性回归分析显示拘禁球囊直径与分支开口面积差正相关(r=0.344,P=0.019)。结论拘禁球囊技术对分支开口具有保护作用,尤其是对真性分叉病变。主动拘禁球囊技术和较大直径的球囊对分支的保护作用可能更明显。

Objective To evaluate the protective effect of jailed balloon technique on side branch(SB)ostium using three-dimensional optical coherence tomography(OCT).Methods This is a retrospective study.Consecutive coronary disease patients with coronary artery bifurcation lesions who underwent percutaneous coronary intervention(PCI)and completed pre-and post-procedural OCT examinations at the Chinese People′s Liberation Army General Hospital from September 2019 to March 2022 were enrolled.Patients were divided into the jailed balloon technique group and the unprotected group according to the options applied for the SB.The SB ostium area difference was calculated from OCT images(SB ostium area difference=post-PCI SB ostium area-pre-PCI SB ostium area).The SB ostium area differences were compared between the two groups and compared further in the subgroup of true bifurcation lesions and non-true bifurcation lesions.In the jailed balloon group,the SB ostium area difference was compared between the active jailed balloon technique and the conventional jailed balloon technique,between the jailed balloon>2.0 mm diameter and the jailed balloon≤2.0 mm diameter,and between the higher balloon pressure(>4 atm,1 atm=101.325 kPa)and the lower balloon pressure(≤4 atm).Multivariate linear regression analysis was used to explore the correlation between the technical parameters of the jailed balloon technique and the SB protection effect.Results A total of 176 patients with 236 bifurcation lesions were enrolled,aged(60.7±9.3)years,and there were 128 male patients(72.7%).There were 67 patients in the jailed balloon technique group with 71 bifurcation lesions and 123 patients in the unprotected group with 165 bifurcation lesions.Fourteen patients had 2 to 3 lesions,which were treated in different ways,so they appeared in the unprotected group and the jailed balloon technique group at the same time.The area difference in SB ostium was greater in the jailed balloon group than in the unprotected group(0.07(-0.43,1.05)mm2 vs.-0.33(-0.83,0.26)mm2,P<0.001),and the results were consistent in the true bifurcation lesion subgroup(0.29(-0.35,0.96)mm2 vs.-0.26(-0.64,0.29)mm2,P=0.004),while the difference between the two groups in the non-true bifurcation lesion subgroup was not statistically significant(P=0.136).In the jailed balloon technique group,the SB ostium area difference was greater in patients treated with the active jailed balloon technique than in those treated with the conventional jailed balloon technique((0.43±1.36)mm2 vs.(-0.22±0.52)mm2,P=0.013).The difference in SB ostium area was greater in those using>2.0 mm diameter jailed balloons than in those using≤2.0 mm diameter jailed balloons(0.25(-0.51,1.31)mm2 vs.-0.01(-0.45,0.63)mm2,P=0.020),while SB ostium area difference was similar between those endowed with higher balloon pressure(>4 atm)compared to those with lower balloon pressure(≤4 atm)(P=0.731).Multivariate linear regression analysis showed that there was a positive correlation between jailed balloon diameter and SB ostium area difference(r=0.344,P=0.019).Conclusions The jailed balloon technique significantly protects SB ostium,especially in patients with true bifurcation lesions.The active jailed balloon technique and larger diameter balloons may provide more protection to the SB.