Clinical Observation Of The Application Of Modified Jailed-Balloon Technique And Jailed-Balloon Technique In The Non-left-main Stem Y-bifurcation Lesions

1.BackgroundPercutaneous coronary intervention(PCI)is the main measure to treat coronary artery stenosis and improve the of heart blood supply for patients with coronary heart disease(CHD).The treatment of bifurcated lesions is often involved in coronary intervention,which accounts for 15%to 20%of the total PCI treatment.Due to the complexity of the lesions,interventional therapy for bifurcation lesions is more difficult,with a high incidence of complications.At present,studies have shown that the dual-stent strategy does not provide more benefits than the single-stent strategy in the interventional treatment of bifurcated lesions.However,single stent technology of the bifurcation lesions can easily lead to side branch(SB)Occlusion,especially in the process of the stenting of main branch(MB),causing symptoms in patients with acute attack and aggravating adverse events.Therefore,how to protect SB safely and effectively in the interventional therapy of the bifurcation lesions is important to percutaneous coronary intervention.Jailed-balloon technique(JBT)is one of the means which are widely applied to protect SB in single-stent strategy of the bifurcation lesions.To a certain extent,the jailed balloon prevent the plaque migration of MB and the change of SB opening structure caused by inflation of MB stent,keeping a certain space for branch openings.In addition,the passage is reserved for further or remedial expansion of the SB,balloon kissing and even the remedial stent for the SB due to the subsequent compression of the SB opening.Modified jailed-balloon technique(MJBT)is an expansion of JBT in interventional therapy in recent years.However,there is not much research data on whether it has practical advantages in the application of bifurcation lesions.2.ObjectiveTo investigate the effect and safety of Modified jailed-balloon technique and jailed-balloon technique for side branch protection in patients with coronary bifurcation lesions.3.Objects and MethodsAccording to inclusion and exclusion criteria,a total of 108 patients who were diagnosed with coronary artery bifurcation lesions by coronary angiography in the department of cardiology and were randomly divided into balloon arrest group and balloon stent implantation group,with 54 patients in each group.Methods:1).In interventional therapy,standard working guidewires was placed in the MB and SB of bifurcation target lesions in both groups,and appropriate balloon was selected to fully pre-expand the MB;2).Patients in the JBT group us.ed JBT to protect SB when implanting MB stent,while patients in the MJBT group used MJBT to protect SB when implanting MB stent.3)_After the release of the MB stents in the two groups,a more expansion of the SB,kissing or the remedial stent can be implanted in the SB if it has obvious severe stenosis,slow flow or Occlusion;4).Postoperative follow-up of 1 year,collect two groups of patients’ age,gender,whether the ACS,hypertension,diabetes,smoking,heart function and preoperative blood lipid levels,troponin levels as general clinical data contrast.Collect preoperative data statistics of the target lesion in patients of two groups,including bifurcation position,angle of bifurcation,branch stenosis,reference diameter of SB,location of the plaques of MB.Collect intraoperative complications including SB Occlusion,dissection,remedial stenting,slow flow,etc.Collect operation time,the contrast agent dosage to make a data statistical analysis.After 1-year follow-up,collect he incidence of MACE and TLR events,postoperative symptoms,blood flow of SB in the angiographic for statistical analysis.4.Results:1).There were no statistically significant differences between the two groups in general clinical data(P>0.05).2).Preoperative related data of target lesion in both group had no statistical difference(P>0.05).3).All patients’ operation are successful.No interlining,slow flow or stent expansion problem of the MB occurred.JMT group had a higher SB loss rate(14.8%VS 1.9%,P<0.05),and a higher SB postoperative immediately slow flow rate(18.5%VS 5.6%,P<0.05)than MJBT group,the result was statistically significant.In terms of SB dissection,there was no significant difference between the two groups(11.1%VS 5.6%,P>0.05).In JBT group,there were 3 cases of SB remedial stenting,while no one case of that in MJBT group,but there was no statistical difference(P>0.05).4).The PCI operation time of patients in the JBT group was greater than that of MJBT group(36.04±21.11min VS 26.76±15.85min,P<0.05),and the dose of contrast agent during PCI used in JBT group was greater than that of MJBT group(48.61±23.92ml VS 38.33±7.95ml,P<0.05).The results were statistically significant.5).After 1 year of postoperative follow-up,no MACE and TLR events occurred between the two groups,no significant difference was found in the expression rate of suspicious angina symptoms between the two groups(P>0.05),and no significant difference was found in the expression rate of SB slow flow during reexamination(P>0.05).5.Conclusions1)Similar to jailed-balloon technique,Modified jailed-balloon technique can protect the side branch safely and effectively.2)The Modified jailed-balloon technique can reduce the risk of side branches Occlusion.And compared to jailed-balloon technique,Modified jailed-balloon technique has a lower degree of immediate postoperative side branch involvement,which can reduce severe stenosis or Occlusion,operation time prolonged,the contrast agent dosage when deal with involved side branch.3)The immediate effect after stent release of modified jailed-balloon technique may be better than that of jailed-balloon technique,but after remedial interventions,immediate postoperative final result of the two technique has no significant difference.And there is no significant difference in long-term effect between the two technique.