The Observtion Of Bifurcation Lesions Before And After Protective Ballooning Technique With Optical Coherence Tomography(OCT)and Quantitative Coronary Angiography(QCA)

Objective:This study used OCT to observe the changing before and after protective ballooning technique in the bifurcation coronary lesions. To observe the organizational structure using optical coherence tomography(OCT). Analyze the changing of the main branch and side branch vessel pre and post-PCI. We evaluated the difference between the data of quantitative coronary angiography(QCA) and OCT.Method:From March 2014 to March 2015, patients who underwent coronary arteriography assessed true bifurcation coronary lesions in 30 patients. The main branch of the bifurcation coronary lesions with stent implantation, while the side branch with protective ballooning technology.Assess coronary atherosclerosis and study the vessel wall response to stent implantation in terms of strut coverage and apposition will be delineated.Measure the lumen area(A),mean diameter(MD),minimal lumen diameter(MLD), reference lumen area(RLA),reference lumen diameter(RLD), percent area stenosis and percent diameter stenosis of main branch and side branch lumen pre and post-PCI. Baseline and postprocedural quantitative coronary angiography(QCA) analysis were performed. Analyze the changing pre and post-PCI. Procedural and immediate clinical outcomes were followed up.Results:After stent implantation, the flow of the main branch and side branch were TIMI3 grade. The guide wire got into the side branch without success in 4 cases.We found thin-cap fibroatheromain, plaque rupture,lipid-rich tissue in culprit vessels of patients with ACS by OCT.We found plaque protrusion in 5 patients with ACS after stent implantation.We found no intimal rupture of the side branch of bifurcation lesions, no stent fracture and malapposition.OCT measured the vessel area of main branch[pre-PCI:1.48±0.57 mm2;postPCI:7.77±1.55mm2,P<0.01].mean diameter [pre-PCI:0.97±0.42 mm;post-PCI: 3.08±0.31 mm,P < 0.01]. area stenosis [pre-PCI:82.66±4.48%;post-PCI:6.96±4.19%,P <0.01].diameter stenosis [pre-PCI:70.87±10.73%;post-PCI:5.49±3.88%,P < 0.01 ].vessel area of side branch [pre-PCI:1.59±0.38 mm2;post-PCI: 2.72±0.57 mm2,P <0.01].mean diameter [pre-PCI:1.08±0.10 mm;post-PCI:1.80±0.24 mm,P<0.01].area stenosis [pre-PCI:62.44±7.66%;post-PCI:33.05±14.26%,P < 0.01].diameter stenosis[pre-PCI:51.77±3.75%;post-PCI: 19.24±10.09%,P<0.01].QCA measured the minimal lumen diameterof main branch [pre-PCI:0.74±0.27mm; post-PCI:3.17±0.28 mm,P<0.01].diameter stenosis [pre-PCI:77.70±7.12%;post-PCI: 2.43±2.03%,P < 0.01].minimal lumen diameter of side branch[pre-PCI:0.90±0.18mm;post-PCI: 1.49±0.26 mm,P < 0.01].diameter stenosis [pre-PCI:59.77±8.29%; post-PCI: 32.61±10.33%,P<0.01].The data of QCA was significantly smaller than OCT. Pre-PCI:minimal lumen diameter of side branch [QCA:0.90±0.18 mm; OCT: 1.08±0.10 mm, P < 0.01].Post-PCI: minimal lumen diameter of side branch [QCA:1.49±0.26 mm; OCT:1.80±0.24 mm, P<0.01].There were 8 cases(26.67%) followed up at least 12 months, 1 of them underwent coronary arteriography assessed the flow of the main branch and side branch were TIMI3 grade; 16 cases(53.33%) of full 6 months;4 cases(13.33%) of full3 months;2 cases(6.67%)of full 1 months. There is no major adverse cardiovascular events happen.Conclusions:Protective ballooning technique is associated with a high procedural success rate,improved SB patency, and a low rate of immediate cardiac events. In patients undergoing percutaneous coronary intervention for true coronary bifurcations,one-stent strategy with balloon protection technique is advantage.OCT can be clearly observed atherosclerotic plaque, stenosis of the vascular,the vessel wall response to stent implantation, the effect of stent implantation on the vessel wall.QCA overestimates the ostial stenosis after single-stent crossover implantation compared to OCT.