Efficacy and safety of long-time pre-dilation with perfusion balloon prior to stent implantation in acute myocardial infarction
K Takihara, K Yamamoto, M Takamatsu, Y Honda, K Kadooka, T Kudo, K Ogata, T Kimura, K Nishihira, N Kuriyama, H Deguchi, M Kitamura, T Kubo, N Tanaka, Y ShibataAbstract
Background
Perfusion balloon, which enables long-time pre-dilation by maintaining coronary blood flow, is expected to enhance thrombus/plaque compression and promote lesion dilation during percutaneous coronary intervention (PCI). On the other hand, direct stenting without pre-dilation aims to avoid unnecessary manipulation of the target lesion and improve epicardial and myocardial reperfusion as well as clinical outcomes.
Purpose
We sought to investigate the efficacy and safety of long-time pre-dilation with perfusion balloon prior to stent implantation as compared to direct stenting in primary PCI for acute myocardial infarction (AMI).
Methods
We studied 279 AMI patients who underwent primary PCI with long-time (180 sec) pre-dilation using a perfusion balloon prior to stent implantation (n = 105) or direct stenting (n = 174). The findings of angiography and intravascular imaging at post-PCI, as well as major adverse cardiovascular events (MACE: defined as a composite of cardiac death, myocardial infarction, or clinically-driven target lesion failure) at one-year follow-up, were compared between the two groups.
Results
Patient and lesion characteristics at baseline were not different between the perfusion balloon pre-dilation group and the direct stenting group. The diameter of perfusion balloon for pre-dilation was 3.0 mm (interquartile range [IQR]: 3.0–3.0 mm). Stent diameter was similar between the two groups. The frequency of post-dilation balloon use was comparable between the two groups. At post-PCI, minimum stent area was numerically larger in the perfusion balloon pre-dilation group than the direct stenting group (7.16 mm2 [IQR: 5.77–8.20 mm2] vs. 6.88 mm2 [IQR: 5.38–8.06 mm2], p = 0.172). Stent expansion index (83 % [IQR: 75–92 %] vs. 78 % [IQR: 69–88 %], p = 0.001) and minimum intra-stent lumen area (6.57 mm2 [IQR: 5.55–8.12 mm2] vs. 5.98 mm2 [IQR: 4.92–7.42 mm2], p = 0.003) were significantly larger in the perfusion balloon pre-dilation group than the direct stenting group. The frequency of irregular thrombus/plaque protrusion was significantly lower in the perfusion balloon pre-dilation group than the direct stenting group (14 % vs. 48 %, p < 0.001). Maximum thrombus/plaque protrusion area was significantly smaller in the perfusion balloon pre-dilation group than the direct stenting group (0.31 mm2 [IQR: 0.00–0.59 mm2] vs. 0.66 mm2 [IQR: 0.00–1.31 mm2], p < 0.001). There was no significant difference between the two groups in the frequency of slow flow/no reflow and distal embolization during PCI, nor in the frequency of MACE at one-year follow-up.
Conclusion
In primary PCI for AMI, the long-time pre-dilation with a perfusion balloon prior to stent implantation, compared to direct stenting, resulted in a larger intra-stent lumen area by reducing irregular thrombus/plaque protrusion without increasing slow flow/no reflow and distal embolization.ESC2026image1For image description, please refer to the figure legend and surrounding text.ESC2026image2For image description, please refer to the figure legend and surrounding text.