Application of side branch protection technique in interventional treatment of intracranial atherosclerotic stenosis / 中国医师杂志

Objective:To investigate the application of side branch protection technique in interventional treatment of intracranial arteriosclerosis stenosis.Methods:We reviewed the patients who underwent interventional treatment of intracranial arteriosclerosis stenosis from November 2018 to May 2021 in Affiliated Drum Tower Hospital of Nanjing University Medical School, and analyzed the role of side branch protection technique in the prevention and treatment of complications. Relevant evaluation indicators including: (1) imaging: patency of blood flow in target vessels and branch vessels; (2) clinical presentation: ischemic stroke or transient ischemic attack (TIA) events within 72 hours and one month follow-up results.Results:A total of 9 patients underwent side branch protection during interventional treatment for intracranial arteriosclerosis stenosis, the blood flow of target vessels was improved obviously after operation, and the blood flow of the affected branches was not affected; no stroke or TIA events occurred in 72 hours after operation and one month follow up.Conclusions:Proper application of side branch protection technique can reduce the perioperative complications effectively during the interventional treatment for intracranial arteriosclerosis stenosis.

The Application of the Technique in the Protection of PCI / 昆明医科大学学报

Objective To explore the treatment of percutaneous coronary intervention (PCI), and to comparatively study on the protection of side support by using the active and passive expansion technique.Method 78 patients with coronary artery disease were protected by using balloon technique, there were two groups: the active expansion group (n=41) and the side support balloon (n=37), the TIMI classification、myocardial perfusion rating (MBG), TIMI myocardial perfusion rating (TMP) and the incidence of marginal vascular interlayer were observed and analyzed. Results After the main support was put in, the proportion of patients with side branches of TIMI、 MBG and TMP was at level 3 and the proportion of patients with active balloon expansion was 93％, the margin expansion group was 84％, the difference was not statistically significant (P＞0.05); the incidence of intersecting vascular interlayer in active dilatation group was 24％, the margin expansion group was 8％, and there were statistical differences (P＜0.05). Conclusions Using the technique of holding balloon to protect the side branches, both the active expansion of the side support balloon and the expansion of the side support balloon can significantly reduce the risk of the main stent placement in the posterior branch of the blood vessel, however the incidence of side branch vascular interlayer was lower.

Effect of jailed-balloon technique on PCI side branch protection / 重庆医学

Objective To evaluate the feasibility of jailed-balloon technique(JBT) in the treatment of true coronary bifurcation lesions.Methods From March 2013 to October 2014,a total of 71 patients who received coronary angiography,were diagnosed as true coronary bifurcation lesions and then underwentpercutaneous coronary intervention(PCI) in the Department of Cardiology of the Second Affiliated Hospital of Kunming Medical University was divided into group A(jailed balloon side branch protection group,28 cases) and group B(traditional side branch protection group,43 cases).The perioperative complications,X-ray exposure time,the number of intervention supplies,the total expenses,the incidence of adverse cardiovascular events and other indicators between the groups were compared,and the feasibility of JBT was evaluated.Results There were no significant differences between the two groups in perioperative complications(P＞0.05),postoperative adverse cardiovascular events and restenosis rate of side branch after angiography(P＞ 0.05),but the PCI related indicators (including the balloon use number,PCI operation time,the amount of X-ray exposure,wire number,the amount of contrast agent and operation cost) in group A were significantly lower than those in group B(P＜0.05).Conclusion JBT applied in the treatment of true coronary bifurcation lesions can reduce the operative time,X-ray irradiation time and related medical expenses.

Serial Morphological Changes of Side-Branch Ostium after Paclitaxel-Coated Balloon Treatment of De Novo Coronary Lesions of Main Vessels

PURPOSE: The effects on the side-branch (SB) ostium, following paclitaxel-coated balloon (PCB) treatment of de novo coronary lesions of main vessels have not been previously investigated. This study was aimed at evaluating the serial morphological changes of the SB ostium after PCB treatment of de novo coronary lesions of main vessels using optical coherence tomography (OCT). MATERIALS AND METHODS: This prospective, single-center observational study enrolled patients with de novo lesions, which were traversed by at least one SB (≥1.5 mm) and were treated with PCB. The SB ostium was evaluated with serial angiographic and OCT assessments pre- and post-procedure, and at 9-months follow-up. RESULTS: Sixteen main vessel lesions were successfully treated with PCB, and 26 SBs were included for analysis. Mean SB ostial lumen area increased at 9-months follow-up (0.92±0.68 mm2 pre-procedure, 1.03±0.77 mm2 post-procedure and 1.42±1.18 mm2 at 9-months). The SB ostial lumen area gain was 0.02±0.24 mm2 between pre- and post-procedure, 0.37±0.64 mm2 between post-procedure and 9-months, and 0.60±0.93 mm2 between pre-procedure and 9-months. The ostial lumen area increased by 3.9% [interquartile range (IQR) of -33.3 to 10.4%] between pre- and post-procedure, 52.1% (IQR of -0.7 to 77.3%) between post-procedure and 9-months and 76.1% (IQR of 18.2 to 86.6%) between pre-procedure and 9-months. CONCLUSION: PCB treatment of de novo coronary lesions of main vessels resulted in an increase in the SB ostial lumen area at 9-months.

Investigation of Mobidity, Prognosis and the Effect of Myocardial Infacfion in Patieuts With Small Side Branch Occlusion During Coronary Bifurcation Intervention / 中国循环杂志

Objective: To investigate the prognostic factor for small side branch (SB) occlusion during coronary bifurcation intervention with the incidence rate of peri-procedural myocardial injury (PMI) in relevant patients. Methods: A total of 925 consecutive patients who received coronary bifurcation intervention were enrolled and there were 949 SB lesions ≤ 2.0 mm conifrmed by quantitative coronary angiography (QCA). The patients were divided into 2 groups: SB occlusion group,n=85, including 86 bifurcation lesions and Non-SB occlusion group,n=840, including 863 bifurcation lesions. The clinical characteristics, QCA findings and PCI procedural conditions were studied by Multivariate logistic regression analyses to explore the independent predictors of SB occlusion and to compare the incidence rate of PMI. Results: The total SB occlusion rate was 9.1% (86/949). SB occlusion group had the higher incidence rate of PMI (26/83, 31.3%) vs (77/821, 9.4%) and peri-operative MI mortality(6/83, 7.2%) vs (11/821, 1.3%) than Non-SB occlusion group, both P Conclusion: Coronary bifurcation lesion patients with SB occlusion had the higher risk of PMI during the interventional procedure.

Risk Prediction Model and Scoring System Analysis in Patients With Side Branch Occlusion During Coronary Bifurcation Intervention / 中国循环杂志

Objective: To establish a risk prediction model and scoring system in patients with side branch (SB) occlusion during coronary bifurcation intervention. Methods: A total of 7007 consecutive patients who received percutanenous coronary intervention (PCI) in our hospital from 2012-02 to 2012-07 were recruited and 1545 patients (with 1601 bifurcation lesions) treated by single stent technique or main vessel stenting ifrst strategy were selected for our study. According to weather SB occlusion occurred during operation, the lesions were divided into 2 groups: Non-SB occlusion group,n=1431 and SB occlusion group,n=114. The data set of the ifrst 1200/1601 lesions by time sequence, was used for establishing the risk model and scoring system, the data set of rest 401 lesions was used for model validation. Results: The modeling data set presented that the relationship between pre-operative main vessel plaque and the position of branch vessel, the main blood vessel pre-stenting TIMI grade, the stenosis degree of pre-operative bifurcation nucleus, the angle of pre-operative bifurcation and the ratio of pre-senting stenosis degree of branch diameter and pre-operative main vessel to branch vessel diameter were the independent risk factors for branch occlusion. The risk model ROC=0.80, 95% CI 0.75-0.85, Hosmer-Lemeshow HLP=1.00; the scoring system ROC=0.76, 95% CI 0.71-0.82, HLP=0.12. The validation data set ROC=0.81, 95% CI 0.73-0.89, HLP=0.77; the scoring system ROC=0.77, 95% CI 0.69-0.86, HLP=0.58. The quartile integration of both data sets indicated that the patients with the integration score ≥ 10 had the higher risk for SB occlusion than those with integration score < 10 during the operation,P<0.001. Conclusion: Our research developed a simple and user-friendly system, it may distinguish the patients with high risk of SB occlusion during bifurcation intervention by quantitative stratiifcation of coronary angiographic imaging.

Comparison of Angiographic Outcomes of Side Branch Ostium at Bifurcation Coronary Lesion between Two-stent and One-stent Techniques

Although the favored strategy for coronary bifurcation intervention is stenting main vessel with provisional side branch (SB) stenting, we occasionally use two-stent strategy. The objective of this study was to investigate the angiographic outcome of SB ostium in two-stent group, compared with one-stent group. We analyzed 199 patients with bifurcation lesion who underwent percutaneous coronary intervention (PCI) with drug-eluting stent and follow up angiography. The patients were divided into one-stent group (167 lesions, 158 patients) and two-stent group (41 lesions, 41 patients). Prior to intervention, SB ostium minimal luminal diameter (MLD) was smaller in two-stent group than in one-stent group (1.08+/-0.55 mm vs. 1.39+/-0.60 mm; P=0.01). But, immediately after PCI, SB MLD of two-stent group became greater than that of one-stent group (2.41+/-0.40 mm vs. 1.18+/-0.68 mm; P<0.01). Six to nine months after PCI, this angiographic superiority in SB MLD of two-stent group persisted (1.56+/-0.71 mm vs. 1.13+/-0.53 mm; P<0.01), although there was larger late loss in two-stent group (0.85+/-0.74 mm vs. 0.05+/-0.57 mm; P<0.01). In terms of target lesion revascularization and target vessel revascularization rates, one-stent group showed better results than two-stent group. We could attain wider long term SB ostium after two-stent strategy than after one-stent strategy.

In-Hospital Outcome of Compromised Small Side Branch after Percutaneous Coronary Intervention.

Background: Side branch occlusion is a well known complication of percutaneous coronary intervention. Although occlusion of small side branches is well tolerated, occlusion of larger side branches may cause more serious complications. After PCI the incidence of complications in patients with compromised side branches smaller than 2 mm is small. Compromising side branches larger than 2 mm can be accompanied by clinical outcomes as non Q-wave MI. This study was undertaken to assess the in-hospital outcomes of compromised small (<2mm) side branch after percutaneous coronary intervention. Methods: This cross sectional analytical study was carried out in the department of cardiology, National Institute of Cardiovascular Diseases, Dhaka during the period of September 2011 to June 2012. A total of 100 consecutive patients with coronary artery disease who underwent elective PCI were included in the study. Study patients were divided into two groups on the basis of presence of compromised small (< 2 mm) side branch. In Group- I, small (< 2 mm) side branch were compromised after PCI and in Group- II, side branches were patent after PCI, with 50 patients in each group. In-hospital outcome were evaluated in both groups. Result: There were no significant differences of the baseline clinical demographics between two groups. Post PCI angina was higher in group I than group II (10.0% vs. 9.0%). Non ST elevation myocardial infarction and significant arrhythmia was identical in both groups (2.0% vs. 2.0%) but hypotension was more in group II than group I (4.0% vs. 2.0%). The findings were statistically insignificant between the study groups. There was no mortality, emergency CABG within 24 hours, ST elevation myocardial infarction, cardiogenic shock or acute left ventricular failure during their hospital course in either group. Conclusion: The present study concluded that compromised small (<2mm) side branch after percutaneous coronary intervention was not associated with adverse in-hospital outcome.

Comparative study in diameter side branch closure between drug eluting stent and bare metal stent implantation / 中国实用内科杂志

Objective To assess the influence on

A Clinical Study on the Minor Myocardial Injury Associated with Percutaneous Coronary Intervention / 中国医师杂志

0 05). In PCI group,the balloon inflation time, the highest inflation pressure and the number of placed stents in the patients with the increased level of cTnI had not significant difference compared with those in the patients without the increased level of cTnI. There were 2 patients with side branch occlusion, whose cTnI level obviously elevated. Conclusion PCI could lead to minor myocardial injury in some patients, the reason of which might be side branch occlusion. The number of placed stents and balloon inflation time were not associated with the minor myocardial injury.

Long-term Clinical and Angiographic Outcomes of Side Branch Occlusion after Coronary Stenting

BACKGROUND: Coronary stent is one of effective and well-accepted treatments for coronary artery diseases. Stenting of coronary lesions, however, sometimes involves the coverage of relatively large side branches located in the vicinity of the target lesion. Serial angiographic changes in side branches of stented coronary segments were analyzed to determine the incidence and clinical outcomes of side branch occlusion. METHODS: Serial angiographic findings of 51 patients who had total 60 side branches originating from the stented segments including large branches more than one millimeter in diameter were analyzed. Side branches were divided into two types:type A (> or =1 mm in diameter, with ostial narrowing>50%), type B (> or =1 mm in diameter, with ostial narrowing>50%). Side branch occlusion was defined as development of total occlusion or morphologic changes from type B to A or reduction of TIMI flow more than I after stenting. RESULTS: After stent deployment, 4 out of 60 side branches occluded totally and 2 out of 4 side branches regained luminal patency with the improvement of TIMI flow (type A, TIMI II) on follow-up coronary angiography. Another one branch which showed type B, TIMI flow II changed into type A, TIMI flow I. There were no clinical cardiovascular events associated with acute side branch occlusion. On follow-up coronary angiogram, side branch occlusion developed in 20 (33.3%) side branches. The incidences were significantly related with in-stent restenosis (11/17, 64.7% in group with retenosis vs. 9/34, 26.4% in group without restenosis, p=0.003). CONCLUSIONS: Acute side branch occlusion can develop in a few stented patients without any clinical deteriorations and delayed side branch occlusion may be associated with in-stent restenosis.