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Effect of Dilating Force During Final Kissing Balloon Postdilatation on Optimal Expansion in Bifurcation Stenting
아주대학교 의료원¹ , 인하대학교 의료원²
임홍석¹, 탁승제 ¹ , 양형모¹ , 박진선¹ , 정명일¹ ,최운정¹ , 황정원¹ ,우성일², 최병주 ¹ ,최소연¹ ,윤명호 ¹ ,황교승¹ ,강수진¹ ,신준한¹
Background: Although final kissing balloon postdilatation (FKB) is one of the most important determinants of angiographic and clinical outcomes after “crush” technique, consensus for optimal standard method of FKB has been lacking. We aimed to evaluate the effect of dilating force during FKB on optimal result after bifurcation stenting with “modified mini-crush technique” (MMCT). Methods: After two coronary angioplasty balloons with different diameter (3.5 mm and 2.5 mm) were inserted side by side into experimental coronary phantom tube, the balloons were inflated with equal pressure and then with equal dilating force derived from Laplace law, sequentially. Magnetic resonance imaging was performed for comparing expansion of the balloons in different dilating settings. Five de novo bifurcation lesions of 5 patients were treated with MMCT and dilated with equal dilating force and equal dilating pressure, sequentially. Angiographic and intravascular ultrasound (IVUS) results were analyzed. Results: In experimental model, the ratio of diameter and cross-sectional area between the two balloons showed more similar results with the intended results (diameter ratio, 2.50mm/3.50mm = 0.71; area ratio, 4.91mm2/9.62mm2 = 0.51) after equal dilating force FKB (diameter ratio, 2.02mm/2.88mm = 0.70; area ratio, 4.62mm2/9.07mm2 = 0.51) compared to equal pressure FKB (diameter ratio, 1.86mm/3.07mm = 0.61; area ratio, 4.26mm2/9.58mm2 = 0.44). IVUS analysis demonstrated minimal stent area (MSA) at side branch ostium tended to be larger after equal dilating force compared to equal pressure FKB (3.98±0.29 mm2 vs. 4.48±0.67 mm2, p=0.182). In contrast, MSA at main vessel was quite same between the two FKB methods (8.38±1.50 mm2 vs. 8.64±1.67 mm2, p=0.357). Conclusions: Equal dilating force other than equal dilating pressure might be more ideal for FKB to achieve optimal result after bifurcation stenting with MMCT.


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