Bifurcation/Left Main Diseases and Intervention
Pre-dilation with a Scoring Balloon on Small Side Branch Occlusions During Long Coronary Stent Implantation
Omuta City Hospital, Japan1
Recently, use of percutaneous coronary intervention in the treatment of long coronary lesions has been expanded, and then we often have to face the issue of small side branch occlusions. In this study, we investigated whether pre-dilation with a scoring balloon catheter could prevent the side branch occlusion during the long (≥30 mm) coronary stent implantation.
We retrospectively collected consecutive patients who underwent percutaneous coronary intervention using at least one long (≥30mm) coronary stent from October 2013 to April 2017, and divided into 2 groups: 1) pre-dilation with a scoring balloon (SC group; 47 patients with 50 lesions), and 2) pre-dilation with a conventional balloon (CV group; 57 patients with 59 lesions). The flow injury after stenting was assessed in all visible side branches originating from the stented lesions except for any protection technique was applied.
There were no significant differences in the patient background, the lesion characteristics and the procedural characteristics between the 2 groups. Used scoring balloon catheters were a dual wire scoring balloon (Scoreflex, Orbus Neich, Hong Kong) for 40 and a triple wire scoring balloon (Lacrosse NSE, Nipro, Osaka) for 7 patients. There were no significant differences in used balloon catheter size, stent size, stent length, stent number and total stent length (2.60 ± 0.38 vs 2.55 ± 0.46 mm, 2.80 ± 0.44 vs 2.80 ± 0.39 mm, 35.1 ± 4.2 vs 34.7 ± 3.4 mm, 1.3 ± 0.5 vs 1.2 ± 0.4, 42.1 ± 12.0 vs 39.5 ± 9.9 mm). Although the number of side branches originating from a stented lesion was 3.6 ± 1.7 vs 3.3 ± 1.5 (p=NS), the proportion of side branch injury after stent deployment was significantly lower in the SC group (12.1 vs 24.0 %, p<0.01), and the occlusion rate of side branches at the final coronary angiography was also lower (8.8 vs 15.8 %, p=0.04).
Lesion preparation with a scoring balloon was associated with the lower occlusion rate of side branches after long stent deployment than a conventional balloon. This simple technique is feasible and useful in the treatment of complex coronary lesions with a long stent.