Medizinische Universität Graz - Research portal
Selected Publication:
Bellmann, F.
Optical coherence tomography evaluation of
Single String bifurcation stenting technique
Humanmedizin; [ Diplomarbeit ] Graz Medical University; 2016. pp.
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- Authors Med Uni Graz:
- Advisor:
- Toth-Gayor Gabor
- Zweiker Robert
- Altmetrics:
- Abstract:
- Background: Since the beginning of the interventional era in cardiology starting with the first successful percutaneous coronary angioplasty in 1977 performed by Andreas Grüntzig and the first stent deployment into a human coronary artery in 1986 by Jacques Puel and Ulrich Sigwart, there has been a continuous development in terms of types of materials used as well as the applied techniques for the stent deployment. As advanced and controllable coronary stenting has become for uncomplicated single lesion treatment, the simultaneous application of two or more stents, which is often seen as the most expedient approach in case of bifurcation lesions, remains a challenge. Over the years many techniques have evolved, always for the purpose of minimizing stent overlap or distortion as well as optimizing the stent apposition and its wall coverage. In order to meet these requirements as much as possible, a new approach called the Single String stenting technique was introduced. The purpose of this diploma thesis is to determine, weather the superiority of this method with regard to the above mentioned variables towards the other established two-stent techniques (Culotte, Crush, Mini-crush) is warranted or not. Material & Methods: 13 Patients with complex bifurcation lesions (involving both the main branch and an important side branch) were included in this trial. For the evaluation of the stent deployment, intracoronary optical frequency domain imaging (OFDI) was used. The image analysis was performed using the Terumo Lunawave console. For the analysis of the stent strut apposition, the post-interventional runs of each bifurcation lesion, including main- and side branch, were selected. All distance measurements of the stent struts were transferred into a Microsoft Excel sheet and analyzed in regard to the target values which were defined as perfect apposition with a strut-vessel wall distance of 0µm as well as marked malapposition with a distance of more than 200µm. Results: All 13 in vivo procedures were successfully performed according to the protocol, whereas only in five cases, the complete data of two post-interventional OFDI pullback runs, namely the MB and the SB run, were available. Regarding the other eight cases, only the MB but not the SB could be analyzed. In all 13 cases, a total number of 465 OCT frames was analyzed and 6370 stent struts were identified for evaluation. All six bifurcation segments considered, an overall number of 3405 stent struts (67 %) showed perfect apposition (=0 µm), whereas marked malapposition (>200µm) was seen in 406 struts (8%). In the important ostial area of the mainbranch, 1665 Stuts (59%) were perfectly apposed and 329 (12%) showed marked malapposition. Conclusions: In this study the feasibility of the single string stenting approach was clearly demonstrated. The procedure was applicable for all participating patients and for this technique, there are basically no limitations regarding the type of stent or the manufacturer. In general, the rates of malapposition this trail yielded are favorable, even if the comparability with the result of other double-stent techniques are not fully possible, due to deviating measurement techniques and the different definition of the target values. At this point, there is no further prediction regarding other important factors like wall coverage and stent overlap possible. In order to be able to draw a final conclusion about the superiority of single string stenting technique towards other double-stent techniques, a comparative clinical trial with an appropriate study size and matching study parameter will be necessary.