Hachidai Takahashi1, Hiromasa Otake1, Toshiro Shinke2, Yoshinobu Murasato3, Yoshihisa Kinoshita4, Masahiro Yamawaki5, Yoshihiro Takeda6, Kenichi Fujii7, Shin-Ichiro Yamada8, Yoshihisa Shimada9, Takehiro Yamashita10, Kazuhiko Yumoto11, Ken-Ichi Hirata1. 1. Department of Cardiovascular Medicine, Kobe University, Kobe, Japan. 2. Department of Cardiovascular Medicine, Kobe University, Kobe, Japan. Electronic address: shinke@med.kobe-u.ac.jp. 3. Department of Cardiology, Cardiovascular Center, Kyushu Medical Center, Fukuoka, Japan. 4. Department of Cardiovascular Medicine, Toyohashi Heart Center, Toyohashi, Japan. 5. Department of Cardiovascular Medicine, Saiseikai Yokohama-Eastern Hospital, Yokohama, Japan. 6. Department of Cardiovascular Medicine, Rinku General Medical Center, Izumi-Sano, Japan. 7. Department of Cardiovascular Medicine, Hyogo Medical College, Nishinomiya, Japan. 8. Department of Cardiovascular Medicine, Himeji Cardiovascular Center, Himeji, Japan. 9. Department of Cardiovascular Medicine, Shiroyama Hospital, Habikino, Japan. 10. Department of Cardiovascular Medicine, Cardiovascular Center Hokkaido Ono Hospital, Sapporo, Japan. 11. Department of Cardiovascular Medicine, Yokohama Rosai Hospital, Yokohama, Japan.
Abstract
BACKGROUND: We sought to clarify the impact of final kissing inflation (FKI) after single stenting of bifurcation lesions on vessel healing. METHODS: From the J-REVERSE registry enrolling 303 bifurcation lesions treated with provisional single stenting using sirolimus- (SES) or everolimus-eluting stent (EES), 65 lesions treated with (n=30) and without (n=35) FKI underwent 9-month follow-up optical coherence tomography. Average stent eccentricity index (SEI: minimum/maximum stent diameter) and neointimal unevenness score (NUS: maximum/average neointimal thickness of the same cross-section) for the proximal, bifurcation, and distal segments were compared between FKI and non-FKI groups. RESULTS: At the proximal segment, the FKI group demonstrated significantly larger average stent area with greater asymmetric stent expansion, and average lumen area remained significantly larger at 9-month follow-up despite a tendency toward greater neointimal proliferation. Jailed strut and thrombus incidence were also significantly lower at the side branch orifice, and NUS was significantly smaller at the bifurcation and proximal segments in the FKI group. CONCLUSIONS: Nine months after SES and EES treatment of bifurcation lesions, FKI reduced proximal-segment luminal narrowing. Considering its homogeneous neointimal distribution and fewer jailed struts, FKI may be beneficial for treating bifurcation lesions.
BACKGROUND: We sought to clarify the impact of final kissing inflation (FKI) after single stenting of bifurcation lesions on vessel healing. METHODS: From the J-REVERSE registry enrolling 303 bifurcation lesions treated with provisional single stenting using sirolimus- (SES) or everolimus-eluting stent (EES), 65 lesions treated with (n=30) and without (n=35) FKI underwent 9-month follow-up optical coherence tomography. Average stent eccentricity index (SEI: minimum/maximum stent diameter) and neointimal unevenness score (NUS: maximum/average neointimal thickness of the same cross-section) for the proximal, bifurcation, and distal segments were compared between FKI and non-FKI groups. RESULTS: At the proximal segment, the FKI group demonstrated significantly larger average stent area with greater asymmetric stent expansion, and average lumen area remained significantly larger at 9-month follow-up despite a tendency toward greater neointimal proliferation. Jailed strut and thrombus incidence were also significantly lower at the side branch orifice, and NUS was significantly smaller at the bifurcation and proximal segments in the FKI group. CONCLUSIONS: Nine months after SES and EES treatment of bifurcation lesions, FKI reduced proximal-segment luminal narrowing. Considering its homogeneous neointimal distribution and fewer jailed struts, FKI may be beneficial for treating bifurcation lesions.
Authors: C K Jaryl Ng; Valeria Paradies; George J Vlachojannis; Han Wei Toh; Hwa Liang Leo; E H Philip Wong; Nicolas Foin; Hui Ying Ang Journal: J Cardiovasc Transl Res Date: 2021-01-06 Impact factor: 4.132