| Objective:To observe the change of simple balloon protection guidewire active about coronary artery bifurcation lesions(BCL) in postoperative vascular diameter and internal structure of the preoperative used by optical coherence tomography(OCT); Comparing the difference about two ways to measure the vascular measurement parameter between OCT and quantitative coronary angiography(QCA); Meanwhile, analysis the differences in disease prognosis of two side branch protection against coronary artery bifurcation. Method:A total of 80 cases to be diagnosed with coronary heart disease by coronary angiography(CAG) which select from March 2014 to September 2015 at the Second Affiliated Hospital of Nanchang University, Department of Cardiology, the 80 cases with 80 target lesions confirmed to be true bifurcation lesions. Then, the use of genotyping Medina are(1,1,1),(1,0,1), in conjunction with angiographic and clinical manifestations stenting pointer. Treated patients enrolled bifurcation lesions using a single side branch stent technology and provide protection. Experimental group of 40 patients using the side branch balloon active protection, control group of 40 patients using a simple guide wire protection. Both preoperative and postoperative application OCT(C7-XRTM) observe the main branch and the side branch plaque changes, with or without intimal tear and dissection; measuring the changes in main branch and branch vessel area, average diameter, minimum diameter, reference vessel area in the average diameter of the reference area stenosis rate and diameter stenosis rate. QCA were used to measure the main branch and branch vessel minimum diameter, reference diameter and diameter stenosis rate before and after surgery. Prior to analysis and compare on measuring differences in vascular surgery vascular parameters change parameters. Two groups of patients were followed up for cardiovascular adverse events, to judge the long-term effects. Conditional review of coronary angiography, OCT. Results:Postoperative angiography confirmed the experimental group the main branch and the side branch blood flow unaffected, which both TIMI 3. Intraoperative stent balloon after kissing balloon withdrawal smoothly and no balloon incarcerated or rupture after stent expansion guide wire withdrawal smoothly, without breaks or interception. After successful stent implantation OCT observed branch vessel guidewire through the main branch stent mesh, 4 patients(10%) did not succeed, which because of throughing hard.The control group after stent implantation withdraw the guidewire smoothly, without guide wire impaction, interception, boundless branch occlusion. 3 cases emerge side branch slow flow, and one case totally occluded with chest pain and ECG changes after surgery, on the trailing edge support Rewire final kissing balloon single stent technology. Postoperative OCT observation branch vessel. 3 patients(7.5%) failed to OCT imaging catheter through the stent mesh after the guide wire through the main branch stent mesh successful. Then final kissing balloon stent technology were successfully observed preoperative and postoperative vascular conditions. No patients were surrounded surgery of myocardial infarction and other major cardiovascular events during hospitalized.Applications balloon Active Protection technology group main branch and branch vessel diameter and area stenosis was significantly reduced. Before and after surgery the main branch vessel area(1.42 ± 0.54 VS 7.66 ± 1.53mm2), area stenosis rate(83.46 ± 4.51% VS 6.99 ± 4.12%), the minimum diameter(0.82 ± 0.16 VS 2.83 ± 0.36mm) and a diameter stenosis rate(72.27 ± 9.73% VS 5.53 ± 3.41%), preoperative and postoperative branch vessel area(1.49 ± 0.36 VS 2.71 ± 0.47 mm2), area stenosis rate(64.24 ± 7.36% VS 31.04 ± 12.25%), the minimum diameter(1.02 ± 0.21 VS 1.64 ± 0.32mm) diameter stenosis rate(51.71 ± 3.45% VS 18.74 ± 9.79%), the differences were statistically significant. However, the simplex guidewire protection technology in the main branch was further exacerbated by the narrow side branch artery stenosis, preoperative and postoperative branch vessel area(1.68 ± 0.32 VS 1.26 ± 0.31 mm2), area stenosis rate(61.17 ± 5.12% VS 72.04 ± 8.25%), the minimum diameter(1.12 ± 0.21 VS 0.94 ± 0.28mm) diameter stenosis rate(53.13 ± 4.59% VS 62.74 ± 6.89%).QCA assessment of the measurement results preoperative and postoperative show that active protection than a simple balloon protection guidewire to improve branch vessel stenosis more pronounced in the experimental group branch vessel minimum diameter(0.90 ± 0.10 VS 1.46 ± 0.26 mm, P <0.01) and diameter stenosis rate(58.97 ± 8.18% VS 31.58 ± 9.83%, P <0.01). The control group branching angioplasty minimum diameter(1.01 ± 0.25 VS 0.82 ± 0.21 mm, P <0.01) and diameter stenosis rate(55.82 ± 7.48% VS 70.31 ± 5.33%, P <0.01) before and after surgery.OCT and QCA are two ways to assess the difference after the branch vessel diameter measurements. Results showed that QCA set of measurements is less than the diameter of OCT group. Experimental group before surgery minimum branch vessel diameters [QCA: 0.90 ± 0.10 mm vs OCT: 1.02 ± 0.21 mm, P <0.01], after surgery [QCA: 1.46 ± 0.26 mm vs OCT : 1.64 ± 0.32 mm, P <0.01]. Control group preoperative minimum diameter branch vessel [QCA: 1.01 ± 0.25 mm vs OCT: 1.12 ± 0.21 mm, P = 0.036], postoperative [QCA: 0.82 ± 0.21 mm vs OCT : 0.94 ± 0.28 mm, P = 0.033].According to CCS classification and episodes to evaluate the efficacy of the two groups after 12 months of follow-up. Results showed that the experimental group was significantly better than the control group, CCS I level in the experimental group VS control group(7.5% VS 15%, P <0.001); CCS II experimental group VS control group(5% VS 10%, P <0.001); Conclusions:In our studies, OCT was observed to compare branch balloon guidewire pure active protection and the protection of the two procedures immediate effect bifurcation process. Which indicated that the balloon Active Protection technology in bifurcation lesions during treatment can significantly improve the side branch stenosis, occlusion or reduce the incidence of slow flow, safety and reliable operation. Guidewire alone does not improve the protection of the side branch stenosis, the vast majority of bifurcation lesions take the side branch blood side branch guidewire protection will increase the side branch ostial stenosis, or significantly affect a single row with stent technology. So the application in true bifurcation lesions in the branch vessel balloon may be active Protection with viable single stent technology.Compared with the QCA, the OCT can be clearly observed in plaque morphology, slight changes in the fine structure of dissection, dissection; accurate measurement vessel area, diameter, to accurately judge the effect of surgery. With OCT guidance downward stent technique can provide exact length and diameter of a stent of choice, prevention of adverse bracket adherent or Overside and reduce the risk of stent thrombosis. In the measurement of the vessel diameter, area, and other parameters of the aspects, OCT measurement data obtained more accurate real, QCA measurements may overestimate the degree of stenosis of blood vessels.Follow-up results after 12 months in the patients suggested that in experimental group and the control group occurred stent restenosis 1 case respectively, with CCS classification attack to evaluate the curative effect of two groups.The results show that the experimental group curative effect was better than control group, CCS class I VS controls(7.5% VS 15%, P < 0.001);CCS II group VS control group(5% VS 10%, P < 0.001), two patients with stent restenosis CCS classification as a level III;... |
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