CORRESPONDENCE: LETTER TO THE EDITOR
Reply
Ricardo A. Costa, MD,
Gary S. Mintz, MD and
Stephane G. Carlier, MD, PhD*
* Columbia University Medical Center, Intravascular Imaging and Physiology, Cardiovascular Research Foundation, 55 East 59th Street, 6th Floor, New York, New York 10022 (Email: scarlier{at}crf.org).
The investigators of the referenced study (1) thank McNab and colleagues for their comments. Regarding questions about the procedural "steps" and final kissing balloon (KB) inflation among non-left main lesions (n = 20) treated with sirolimus-eluting stent (SES) crush stenting and final intravascular ultrasound (IVUS) in both branches, the responses are as follows:
- 1 Only 40% (8 of 20 patients) had a separate high-pressure inflation (>12 atm) in the side branch (SB) before KB;
- 2 final KB inflation (90%) was performed in the main vessel (MV) with a balloon of the same size as the "deployment" balloon in 89% (16 of 18 patients), with a smaller balloon in 5.6% (1 of 18 patients), and with a larger balloon in 5.6% (1 of 18 patients);
- 3 final KB inflation was performed in the SB using a same-size balloon (same as "deployment" balloon) in all but one case, 94.4% (17 of 18 patients); in one case a smaller balloon was used;
- 4 the pressure of the KB inflation was 10.4 ± 4.1 atm in the MV and 14.3 ± 3.8 atm in the SB.
When we consider these analyses in lesions with minimum stent area (MSA) at the SB ostium <4 mm2 versus MSA >4 mm2, we found:
- 1 similar rates of high-pressure balloon inflation in the SB prior to KB (42% vs. 38%, p = 0.8);
- 2 balloon pressure at the SB during KB was 14.6 ± 3.8 atm (<4 mm2) versus 15.6 ± 2.8 atm (>4 mm2), p = 0.6.
In addition, a comparison of lesions with incomplete crush (IC) versus "complete" crush (CC) showed that:
- 1 33% of lesions with IC had SB high-pressure inflation before KB versus 25% of lesions with CC, p = 0.6;
- 2 IC had lower balloon pressure during KB in the SB (12.3 ± 3.7 atm for IC vs. 17 ± 3.8 atm for CC; p = 0.04).
Finally, we could not demonstrate any impact of high-pressure balloon inflation in the SB before KB on final luminal dimensions in the SB and on the incidence of IC; this may be due to the small sample size. However, these results showed that higher balloon pressures in the SB during KB inflation are associated with complete "crush" stent apposition, indicating that IC is associated with SB stent underexpansion (1).
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References
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- Costa RA, Mintz GS, Carlier SG, et al. Bifurcation coronary lesions treated with the "crush" technique—an intravascular ultrasound analysis J Am Coll Cardiol 2005;46:599-605.[Abstract/Free Full Text]
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