Vascular healing after kissing balloon inflation: Nine-month 3D optical coherence tomography analysis in corelab. (June 2022)

• Record Type: Journal Article
• Authors: Yamawaki, Masahiro; Okamura, Takayuki; Nagoshi, Ryoji; Fujimura, Tatsuhiro; Murasato, Yoshinobu; Ono, Shiro; Serikawa, Takeshi; Hikichi, Yutaka; Norita, Hiroaki; Nakao, Fumiaki; Sakamoto, Tomohiro; Shinke, Toshiro; Shite, Junya
• Is Part Of: IJC heart & vasculature. Volume 40(2022)
• Publication Date: 2022-06
• Subjects: PCI Percutaneous coronary intervention -- OCT optical coherence tomography -- LFD link-free and distal guidewire recrossing -- SB side branch -- MV main vessel -- ISA incomplete stent apposition -- KBT kissing balloon technique -- CBLs coronary bifurcation lesions -- NUS neointima unevenness score -- POT proximal optimization technique -- LA lumen area -- SA stent area -- NIA neointima area -- NIT neointima thickness -- SEI stent eccentricity index -- QCA quantitative coronary angiographic analysis -- DS diameter stenosis -- MSA Minimum stent area -- WSS wall shear stress -- MEI minimum expansion index -- SBO side branch orifice; Percutaneous coronary intervention -- Coronary bifurcation lesions -- Kissing balloon technique -- Optical coherence tomography -- Drug eluting stent; Cardiovascular system -- Diseases -- Periodicals; Cardiovascular system -- Pathophysiology -- Periodicals; 616.1005
• DOI: 10.1016/j.ijcha.2022.101034
• Languages: English
• ISSNs: 2352-9067

Abstract

Abstract: Background: The jailing strut configuration with link-free and distal guidewire recrossing (LFD) at the side branch orifice (SBO) reduces incomplete stent apposition (ISA) after kissing balloon technique (KBT) in crossover stenting of coronary bifurcation lesions (CBLs). However, data regarding vascular healing after KBT are lacking. We investigated vascular healing 9 months after crossover stenting followed by KBT with optical coherence tomography (OCT) guidance in a prospective multicenter registry. Methods: Fifty-nine patients with CBLs (LFD, 35 patients; non-LFD, 24 patients) were studied. The jailing configuration of the SB and the wire-recrossing position, incidence of ISA and uncovered struts, and neointima unevenness score (NUS) in the main vessel (MV) after 9 months were determined by off-line 3D-OCT in the core laboratory. Results: The ISA rate was significantly higher at the SB ostium and distal MV after KBT in the non-LFD group, compared to the LFD group. After 9 months, incidence of ISA (18.3 ± 18.2 vs. 6.0 ± 8.7%, p < 0.01) and uncovered struts (8.7 ± 9.9 vs. 4.7 ± 7.3 %, p = 0.08) were higher at the SB ostium with higher SB restenosis in the non-LFD group. In distal MV, NUS was significantly higher (3.1 ± 1.1 vs. 2.5 ± 0.6, p < 0.05). In true-CBLs, an increase in uncovered struts and ISA rate was prominent in the proximal MV and opposite SB. No differences were observed in the 9-month clinical outcomes. Conclusion: Visualization of the wire recrossing point and the SB-jailing strut pattern by OCT plays an important role to optimize the KBT in CBL stenting, resulting in favorable mid-term vascular healing.