| OBJECTIVEInvestigate the safety and feasibility of the use of 7 Fr sheath guiding catheters in true LMCA bifurcation lesions via transradial approach,explore the role of the jailed balloon technique(JBT)in protecting the LAD during step-by-step double stenting for true LMCA bifurcation lesions,and find out whether use of optimized kissing techniques,proximal optimization technique and MINI double stenting techniques can further reduce the incidence 1-year MACEs.METHODSIn Chapter 1,182 patients with true LMCA bifurcation lesions in the transradial approach were enrolled and divided into two groups:7 Fr sheath GC group(Group A,n = 91)and 6 Fr sheath GC group(Group B,n = 91).Success rate of operation,catheter arrival time,final success rate of kissing balloon inflation,and incidence of complications seen in the transradial approach were analyzed for both groups.In Chapter 2,122 patients with true LMCA bifurcation lesions in the transradial approach were enrolled and divided into two groups:JBT(Group A,n = 58)and JWT groups(Group B,n = 64).Clinical efficacy was compared.In Chapter 3,103 patients with true LMCA bifurcation lesions in the transradial approach were enrolled and divided into three groups:MINI-culotte stenting(Group A,n = 31),TAP-stenting(Group B,n = 48),and modified T-stenting groups(Group C,n = 24).Efficacy and incidence of one-year MACEs were compared among three groups.RESULTSChapter 1The 7 Fr sheath GC group was superior to the 6 Fr sheath GC group regarding catheter arrival time(68.4 s ± 13.8 s versus 75.2 s ± 11.6 s),success rate of operation(98.4%versus 86.8%),and final success rate of kissing balloon inflation(100%versus 94.5%);among them,the difference in catheter arrival time was statistically significant(P = 0.000),whereas differences in the latter two were statistically insignificant.The incidence of radial artery spasm,forearm hematoma and radial artery occlusion at 3 months of follow-up was higher in the 7 Fr sheath GC group than in the 6 Fr sheath GC group,among which,the difference in incidence of radial artery spasm was statistically significant(P = 0.048),whereas differences in the latter two were statistically insignificant,without observed severe complication.Chapter 2Comparisons of TIMI flow and complications during PCI of the left anterior descending(main branch):In the JBT group(Group A),slow blood flow was observed in three patients(5.2%),which was restored after slight jailed ballooning,without persistent angina pectoris.In the JWT groups(Group B),slow blood flow was observed in 12 patients(17.2%)and side-branch occlusion in one(1.6%),who was also complicated with immediate hemodynamic instability and ventricular fibrillation.The incidence of complications was significantly higher in the JWT group than in the JBT group(P = 0.028),and the difference was statistically significant.Chapter 3For incidence of MACEs:There were four patients who underwent clinical symptom-driven recanalization of target vessels within one year(3.9%;two underwent CABG in Group A and Group B,and two underwent drug eluting balloon dilatation in Group B and Group C),and there were no statistical differences among three groups.All patients underwent follow-up coronary angiography within a year,6(5.8%)of whom had restenosis(one in Group A,three in Group B,and two in Group C),and there were no statistical differences among three groups.Coronary angiography found one patient with advanced stent thrombosis in the modified T-stenting group(Group C).No patient reported sudden and unexplained death,definite cardiac death,acute myocardial infarction,or cardiogenic shock.CONCLUSION1.Transradial 7 Fr sheath GC is a safe and feasible option.2.Use of JBT can reduce the incidence of MACEs in LMCA bifurcation lesions and of TIMI blood flow retardation of the main branch and lower balloon-related consumable expenses during PCI.3.MINI double stenting for true LMCA bifurcation lesions protects main vessels from multilayer stenting and further reduce the incidence of restenosis and revascularization of target vessels. |
