Kissing molars (KMs) is a condition of occlusal molar surfaces in a single follicular space with roots extending in opposite directions. Here, we have reported a case of KMs in a 58-year-old woman. The patient complai...Kissing molars (KMs) is a condition of occlusal molar surfaces in a single follicular space with roots extending in opposite directions. Here, we have reported a case of KMs in a 58-year-old woman. The patient complained of pain in the right mandibular molar region and was diagnosed with KMs consisting of the right mandibular second and third molars. Because of the patient’s pain having subsided at the time of the visit and her unwillingness to undergo tooth extraction, the patient was followed up. KMs is classified into three classes (I-III) and is either true-KMs or pseudo-KMs and presents with or without cystic variants of dental follicles. The presents as true-KMs class II without a cystic variant. With reference to the literature and based on our analysis, the mean age of patients affected by this specific case of KMs is 31.7 years and unilateral KMs is relatively more common (85.7%). Histopathological findings of dentigerous cysts are more often indicated (42.9%). The treatment policy for KMs should therefore be based on the classification of KMs. Importantly, the focus should be on preserving the first and second molars as much as possible. The treatment approach, such as the employment of surgical removal or orthodontics, should be determined by considering the associated factors such as the crowns, tissues, and age of the patient.展开更多
A 67-year-old male presented with a gradually progressive low back pain of 2 years duration. The patient was leading a retired life and there was no history of chronic fever or significant trauma. There was no radiati...A 67-year-old male presented with a gradually progressive low back pain of 2 years duration. The patient was leading a retired life and there was no history of chronic fever or significant trauma. There was no radiation of pain or any features suggestive of claudication. There was no history of any comorbidity. The pain was aggravated with extension of the spine and relieved with flexion. There was no swelling or neurological deficit, but muscle spasm was present. Radiographs of the spine revealed degenerative changes in the lumbosacral spine, along with articulation of spinous processes at in lumbar spine at all levels level suggestive of Baastrup's disease, commonly known as "kissing spine". Routine blood investigations were within normal limits. The patient was managed conservatively. He was given a week's course of analgesics and muscle relaxants and then started on spinal flexion exercises, with significant improvement being noted at 6 months follow up.展开更多
BACKGROUND Kissing molars(KMs)are a scarcely reported form of molar impaction in which the occlusal surfaces contact each other within a single dental follicle and the roots point in opposite directions.The direction ...BACKGROUND Kissing molars(KMs)are a scarcely reported form of molar impaction in which the occlusal surfaces contact each other within a single dental follicle and the roots point in opposite directions.The direction of KMs impaction is generally tilted.KMs with vertical direction impaction have not been reported in the literature.CASE SUMMARY A 25-year-old female visited a dentist for right maxillary wisdom teeth extraction and was diagnosed with two vertically impacted KMs in the left mandible on panoramic radiography.After cone-beam computed tomography examination confirmed no secondary complication,the patient chose to undergo observation and regular follow-up.A literature review of KMs revealed that vertical impacted KMs are rare;high-quality evidence regarding their prevalence is still lacking.At present,the causality of KMs is controversial.In this study,we have tried to provide a detailed definition of KMs to allow an accurate evaluation of their prevalence and classification based on their impaction direction which may be related to their pathogenesis.The treatment plan of KMs depends on the condition and location of the affected teeth and associated complications;they may be either directly extracted or treated using a multidisciplinary approach including maxillofacial surgeons and orthodontists.CONCLUSION KMs are a rare clinical condition of impacted teeth with unclear pathogenesis.Vertically impacted KMs were seldom reported.Reasonable definition and classification of KMs can help in the understanding of their causes and prevalence.展开更多
BACKGROUND A post-bulbar duodenal ulcer(PBDU)is an ulcer in the duodenum that is distal to the duodenal bulb.PBDU may coexist with a synchronous posterior ulcer in rare occurrences,resulting in a kissing ulcer(KU).Duo...BACKGROUND A post-bulbar duodenal ulcer(PBDU)is an ulcer in the duodenum that is distal to the duodenal bulb.PBDU may coexist with a synchronous posterior ulcer in rare occurrences,resulting in a kissing ulcer(KU).Duodenocaval fistula(DCF)is another uncommon but potentially fatal complication related to PBDU.There is limited knowledge of the scenarios in which PBDU is complicated by KU and DCF simultaneously.CASE SUMMARY A 22-year-old man was admitted to the emergency department with abdominal pain,stiffness,and vomiting.The X-ray showed pneumoperitoneum,suggesting a perforated viscus.Laparotomy revealed a KU with anterior perforation and a DCF.After Kocherization,venorrahphy was used to control caval bleeding.Due to the critical condition of the patient,only primary duodenorrahphy with gastrojejunostomy was performed as a damage control strategy.However,later,the patient developed obstructive jaundice and leakage,and two additional jejunal perforations were detected.Due to the poor condition of the duodenum and the involvement of the ampulla in the posterior ulcer,neither primary repair nor pancreatic-free duodenectomy and ampull-oplasty/ampullary reimplantation were considered viable;therefore,an emergency pancreaticoduodenectomy was performed,along with resection and anastomosis of the two jejunal perforations.The patient had a smooth recovery after surgery and was discharged after 27 d.CONCLUSION The timely diagnosis of PBDU and radical surgery can aid in the smooth recovery of patients,even in the most complex cases.展开更多
By measuring and analyzing the crystallization activation energy (CAE) of Fe-based amorphous alloy Fe79B16Si5 and Fe78B13Si9, it is reconfirmed and further analyzed that the conventional Kissinger method does not conf...By measuring and analyzing the crystallization activation energy (CAE) of Fe-based amorphous alloy Fe79B16Si5 and Fe78B13Si9, it is reconfirmed and further analyzed that the conventional Kissinger method does not conform with the premise of Kissinger equation, namely, samples with different heating rates should keep a constant fraction of transformation at the exothermal peak temperature Tp of DSC thermogram. The XRD equal first peak height (EFPH) method is applied to CAE measurement of Fe-based amorphous alloy for the first time. It is shown again that the EFPH method coincides with the premise of Kissinger equation. The procedure of EFPH method is introduced in detail in this paper. The accuracy in determining CAE of amorphous alloy may be improved by applying the EFPH method. As a result, the mechanism of embrittlement of amorphous alloy may be better elucidated.展开更多
Objective: The aim of this study was to investigate whether intermediate kissing balloon dilation(IKBD) is necessary during mini-culotte stenting(MCS) and how it can be properly conducted. Methods: MCS was emulated in...Objective: The aim of this study was to investigate whether intermediate kissing balloon dilation(IKBD) is necessary during mini-culotte stenting(MCS) and how it can be properly conducted. Methods: MCS was emulated in a bifurcation model with a branch diameter difference(BDD) in three-step sizes of 0.50, 0.75 and 1.00 mm, and with intermediate balloon dilation(IBD) in three treatments of routine intermediate solo balloon dilation(rISBD), concurrent IKBD(cIKBD) or sequential IKBD. Microcomputed tomography was performed to assess stent under-expansion(SUE) around the polygon of confluence(POC), residual ostial stenosis(ROS) at the ostial side-branch(SB) and main-branch(MB) and stent cell distortion(SCD) in the bifurcation segments. Results: There were both main and interactive effects of IBD and BDD on ROS at the ostial SB and SCD in the ostial SB, but there were only main effects of IBD or BDD on SUE around the POC, ROS at the ostial MB and SCD in the ostial MB. Analysis of the main effects showed that SUE around the POC or ROS at the ostial SB was significantly different between sI KBD and rISBD and between cI KBD and rISBD. There was also a significant difference in SCD in the ostial SB between sI KBD and rI SBD and between sI KBD and cIKBD. Analysis of the interactive effects showed that ROS at the ostial SB or SCD in the ostial SB was affected by all IBD treatments in all BDD step-sizes. Moreover, increasing the BDD step-sizes significantly increased ROS at the ostial SB as treated by rISBD and SCD in the ostial SB as treated by rISBD or cIKBD. Conclusions: SIKBD was shown to be essential and superior to rISBD or cIKBD, resulting in better bifurcated stent expansion and coverage when using MCS.展开更多
Kissing molars (KMs), first reported by Van Hoof in 1973, refer to molars with occlusal surfaces that contact each other in a single follicular space while their roots extend in opposite directions. This is a case of ...Kissing molars (KMs), first reported by Van Hoof in 1973, refer to molars with occlusal surfaces that contact each other in a single follicular space while their roots extend in opposite directions. This is a case of a 20-year-old male who presented with complaints of right mandibular molar pain with cold water contact and occlusion. Panoramic and cone-beam computed tomography (CBCT) images revealed impaction of the right mandibular third and fourth molars, with the occlusal surfaces contacting each other while the roots extended in opposite directions. KMs are classified according to the impaction of the mandibular first and second molars (Class I), second and third molars (Class II), and third and fourth molars (Class III). Our patient was considered Class III. Given the patient’s preference for surgical treatment, successful teeth extraction and extirpation were performed under intravenous sedation. The patient’s postoperative course was unremarkable. We describe a case of KMs Class III with a cystic variant assessed by panoramic and CBCT images. We additionally review all KMs Class III reported in the literature.展开更多
Kissing bonds are defects in the adhesive bonds with intimate contact of touching surface but considerably lowered shear strength. Their detection specifically in the aerospace area is so not satisfactory. Usually, ki...Kissing bonds are defects in the adhesive bonds with intimate contact of touching surface but considerably lowered shear strength. Their detection specifically in the aerospace area is so not satisfactory. Usually, kissing bonds are inconspicuous in ultrasonic C-scans. However, the determination of attributes in the time domain and the frequency domain of an ultrasound signal provides the opportunity to derive a pattern for bonded area. Deviations from the pattern found in inconspicuous bonding areas indicate kissing bonds. The survey described here deals with the manufacturing of adhesively joint samples that purposefully include kissing bonds, as well as potential solutions for detecting them through ultrasonic testing combined with pattern recognition. The properties of the epoxy-based adhesive were varied by changing the mixing ratios between resin and hardener. Samples with a mixing ratio far apart from the manufacturer’s recommendation with an inconspicuous appearance in a C-scan, but low shear strength values were taken for further evaluation. After a definition and learning phase, a 100 percent hit rate to separate good bondings from kissing bonds could be derived in a blind test. The discriminating feature found is due to the frequency shift between good and kissing bonds as well as the relative amplitude of the second peak.展开更多
Background The mechanisms responsible for the occurrence of a kissing unsatisfied （KUS） result after classical crush stenting remain unclear. The present study aimed at analyzing the mechanisms and clinical signific...Background The mechanisms responsible for the occurrence of a kissing unsatisfied （KUS） result after classical crush stenting remain unclear. The present study aimed at analyzing the mechanisms and clinical significance of KUS. Methods Two hundred and thirteen patients with true bifurcation lesions treated with classical crush stenting and final kissing balloon inflation （FKBI） were assigned to upper, middle, and lower groups according to the position of the side branch re-wiring assessed by visual estimation, quantitative coronary analysis （QCA） and intravascular ultrasound （IVUS）. Angiographic follow-up was indexed at 12 months. Results The upper group was characterized by a larger bifurcation angle of 55.53°±25.25° （P=0,030） and a longer procedural time （42.43±23.92） minutes （P=0.015）. The overall rate of KUS by visual estimation was 10.48%, with 5.4% in the upper group, 3.9% in middle group, and 36.1% in lower group （P 〈0.001）. For the diagnosis of KUS, visual inspection demonstrated a good correlation with both QCA and IVUS. Smaller stent diameter was the main reason for KUS in the upper group, while extra-stent side wire location, or re-wire in a low position was the main mechanism attributed to KUS in the lower group. The Lower group had more restenosis, with most restenotic lesions at a lower position of the side branch ostium. KUS （HR 1.652, 95% Cl 1.332-2.088, P 〈0.001） and re-wiring position （HR 2.341, 95% Cl 1.780-4.329, P 〈0.001） were two independent predictors of side branch restenosis. Re-wiring position （OR 0.458, 95%C/0.336-0.874, P=0.001） and side stent expansion （OR 3.122, 95%C/2.883-5.061, P=0.014） were factors predicting the findings of KUS. Conclusions Side wire outside side stents resulted in more KUS and restenosis. Different restenotic lesion types reflected individual mechanisms contributing to the development of plaque proliferation.展开更多
Background Fractional flow reserve （FFR）-guided percutaneous coronary intervention （PCI） is associated with fewer unfavorable events. However, the hemodynamic change in FFR after different stenting approaches for ...Background Fractional flow reserve （FFR）-guided percutaneous coronary intervention （PCI） is associated with fewer unfavorable events. However, the hemodynamic change in FFR after different stenting approaches for bifurcation lesions is still not fully studied. The aim of this study was to analyze the hemodynamic changes in FFR after double kissing （DK） crush and provisional side branch （SB） stenting （PS） for true coronary bifurcation lesions. Methods Seventy-five patients with true bifurcated lesions were randomly divided into DK （n=38） and PS （n=37） groups. Additional SB stenting in the PS group was required if there was any pinched SB ostium 〉70% stenosis, or ≥ type B dissection, or TIMI flow 〈grade 3. FFR at hyperemia in the main vessel （MV） and SB was measured prior- and post-stenting, and at 8 months follow-up. Results Baseline clinical, angiographic and lesion characteristics were matched well between the two groups, with the exception of the final kissing balloon inflation （FKBI, 100.0% in the DK vs. 83.8% in the PS group, P 〈0.001）. Baseline FFR was comparable between the DK and the PS groups, however, the acute gain and late loss of SB FFR at 8-month follow-up in the DK group were 0.18±0.15 and -0.06±0.11, compared to 0.12±0.18 （P=0.044） and -0.002±0.07 （P=-0.037） in the PS group, respectively. MV FFR post-stenting 〉0.94 was seen in about 40% of patients. There was no significant difference in the clinical events at 1-year follow-up between the two groups. Conclusions DK crush was associated with improved acute gain and late loss of SB FFR. The lower rate of FFR 〉0.94 after stenting underscored the further improvement of stentinq quality.展开更多
Standards for treating bifurcation lesions are crucial due to poor outcomes by percutaneous implantation of either bare metal stents or drug-eluting stents, even with several modified double-stent techniques including...Standards for treating bifurcation lesions are crucial due to poor outcomes by percutaneous implantation of either bare metal stents or drug-eluting stents, even with several modified double-stent techniques including ＂T＂, ＂V＂, ＂Y＂, ＂culotte＂ and ＂simultaneous kissing stents （SKS）＂. Understanding the drawbacks in classical crush techniques, we proposed a novel double kissing （DK） crush technique being testified in our previous serial studies]＇2 The results from these randomized and pilot studies are describing a fantastic story---DK crush technique, by final kissing balloon inflation （FKBI） in 100% of lesions and high quality of kissing as assessed by both angiography and intravascular ultrasound, significantly improved the clinical outcome at a relative short-term follow-up. However, whether the advantage of the DK crush technique was sustained or not at a long-term remains unclear. The present study aimed to extend clinical follow-up and verify the differences between DK and classic crush techniques.展开更多
Double kissing(DK)crush stenting for coronary bifurcation lesions has gain popularity worldwide because of its superior randomized studies data and excellent clinical outcomes.This review evaluates all DK crush clinic...Double kissing(DK)crush stenting for coronary bifurcation lesions has gain popularity worldwide because of its superior randomized studies data and excellent clinical outcomes.This review evaluates all DK crush clinical trials and studies.It also reveals the contemporary technique steps by steps as well as the trouble shooting with illustrated clinical scenarios.Among all the available evidence,the DK crush technique is superior when compared to the provisional stenting technique for complex bifurcation lesion.DK crush stenting provides the best evidence-based approach to complex bifurcation lesions especially the left main coronary artery bifurcation lesions.Future direction of how to make this DK crush technique better is also proposed.展开更多
文摘Kissing molars (KMs) is a condition of occlusal molar surfaces in a single follicular space with roots extending in opposite directions. Here, we have reported a case of KMs in a 58-year-old woman. The patient complained of pain in the right mandibular molar region and was diagnosed with KMs consisting of the right mandibular second and third molars. Because of the patient’s pain having subsided at the time of the visit and her unwillingness to undergo tooth extraction, the patient was followed up. KMs is classified into three classes (I-III) and is either true-KMs or pseudo-KMs and presents with or without cystic variants of dental follicles. The presents as true-KMs class II without a cystic variant. With reference to the literature and based on our analysis, the mean age of patients affected by this specific case of KMs is 31.7 years and unilateral KMs is relatively more common (85.7%). Histopathological findings of dentigerous cysts are more often indicated (42.9%). The treatment policy for KMs should therefore be based on the classification of KMs. Importantly, the focus should be on preserving the first and second molars as much as possible. The treatment approach, such as the employment of surgical removal or orthodontics, should be determined by considering the associated factors such as the crowns, tissues, and age of the patient.
文摘A 67-year-old male presented with a gradually progressive low back pain of 2 years duration. The patient was leading a retired life and there was no history of chronic fever or significant trauma. There was no radiation of pain or any features suggestive of claudication. There was no history of any comorbidity. The pain was aggravated with extension of the spine and relieved with flexion. There was no swelling or neurological deficit, but muscle spasm was present. Radiographs of the spine revealed degenerative changes in the lumbosacral spine, along with articulation of spinous processes at in lumbar spine at all levels level suggestive of Baastrup's disease, commonly known as "kissing spine". Routine blood investigations were within normal limits. The patient was managed conservatively. He was given a week's course of analgesics and muscle relaxants and then started on spinal flexion exercises, with significant improvement being noted at 6 months follow up.
基金Supported by Strategic Cooperation Project between Sichuan University and Luzhou Municipal Government,No. 2018CDLZ-14Aba Tibetan and Qiang Autonomous Prefecture Science and Technology Bureau,No. 21YYJSYJ0052
文摘BACKGROUND Kissing molars(KMs)are a scarcely reported form of molar impaction in which the occlusal surfaces contact each other within a single dental follicle and the roots point in opposite directions.The direction of KMs impaction is generally tilted.KMs with vertical direction impaction have not been reported in the literature.CASE SUMMARY A 25-year-old female visited a dentist for right maxillary wisdom teeth extraction and was diagnosed with two vertically impacted KMs in the left mandible on panoramic radiography.After cone-beam computed tomography examination confirmed no secondary complication,the patient chose to undergo observation and regular follow-up.A literature review of KMs revealed that vertical impacted KMs are rare;high-quality evidence regarding their prevalence is still lacking.At present,the causality of KMs is controversial.In this study,we have tried to provide a detailed definition of KMs to allow an accurate evaluation of their prevalence and classification based on their impaction direction which may be related to their pathogenesis.The treatment plan of KMs depends on the condition and location of the affected teeth and associated complications;they may be either directly extracted or treated using a multidisciplinary approach including maxillofacial surgeons and orthodontists.CONCLUSION KMs are a rare clinical condition of impacted teeth with unclear pathogenesis.Vertically impacted KMs were seldom reported.Reasonable definition and classification of KMs can help in the understanding of their causes and prevalence.
文摘BACKGROUND A post-bulbar duodenal ulcer(PBDU)is an ulcer in the duodenum that is distal to the duodenal bulb.PBDU may coexist with a synchronous posterior ulcer in rare occurrences,resulting in a kissing ulcer(KU).Duodenocaval fistula(DCF)is another uncommon but potentially fatal complication related to PBDU.There is limited knowledge of the scenarios in which PBDU is complicated by KU and DCF simultaneously.CASE SUMMARY A 22-year-old man was admitted to the emergency department with abdominal pain,stiffness,and vomiting.The X-ray showed pneumoperitoneum,suggesting a perforated viscus.Laparotomy revealed a KU with anterior perforation and a DCF.After Kocherization,venorrahphy was used to control caval bleeding.Due to the critical condition of the patient,only primary duodenorrahphy with gastrojejunostomy was performed as a damage control strategy.However,later,the patient developed obstructive jaundice and leakage,and two additional jejunal perforations were detected.Due to the poor condition of the duodenum and the involvement of the ampulla in the posterior ulcer,neither primary repair nor pancreatic-free duodenectomy and ampull-oplasty/ampullary reimplantation were considered viable;therefore,an emergency pancreaticoduodenectomy was performed,along with resection and anastomosis of the two jejunal perforations.The patient had a smooth recovery after surgery and was discharged after 27 d.CONCLUSION The timely diagnosis of PBDU and radical surgery can aid in the smooth recovery of patients,even in the most complex cases.
文摘By measuring and analyzing the crystallization activation energy (CAE) of Fe-based amorphous alloy Fe79B16Si5 and Fe78B13Si9, it is reconfirmed and further analyzed that the conventional Kissinger method does not conform with the premise of Kissinger equation, namely, samples with different heating rates should keep a constant fraction of transformation at the exothermal peak temperature Tp of DSC thermogram. The XRD equal first peak height (EFPH) method is applied to CAE measurement of Fe-based amorphous alloy for the first time. It is shown again that the EFPH method coincides with the premise of Kissinger equation. The procedure of EFPH method is introduced in detail in this paper. The accuracy in determining CAE of amorphous alloy may be improved by applying the EFPH method. As a result, the mechanism of embrittlement of amorphous alloy may be better elucidated.
基金support of the National Natural Science Foundation of China(Grant No.81370311)the Key Program of Social Development of Fujian Science and Technology Department(Grant No.2013Y0043)
文摘Objective: The aim of this study was to investigate whether intermediate kissing balloon dilation(IKBD) is necessary during mini-culotte stenting(MCS) and how it can be properly conducted. Methods: MCS was emulated in a bifurcation model with a branch diameter difference(BDD) in three-step sizes of 0.50, 0.75 and 1.00 mm, and with intermediate balloon dilation(IBD) in three treatments of routine intermediate solo balloon dilation(rISBD), concurrent IKBD(cIKBD) or sequential IKBD. Microcomputed tomography was performed to assess stent under-expansion(SUE) around the polygon of confluence(POC), residual ostial stenosis(ROS) at the ostial side-branch(SB) and main-branch(MB) and stent cell distortion(SCD) in the bifurcation segments. Results: There were both main and interactive effects of IBD and BDD on ROS at the ostial SB and SCD in the ostial SB, but there were only main effects of IBD or BDD on SUE around the POC, ROS at the ostial MB and SCD in the ostial MB. Analysis of the main effects showed that SUE around the POC or ROS at the ostial SB was significantly different between sI KBD and rISBD and between cI KBD and rISBD. There was also a significant difference in SCD in the ostial SB between sI KBD and rI SBD and between sI KBD and cIKBD. Analysis of the interactive effects showed that ROS at the ostial SB or SCD in the ostial SB was affected by all IBD treatments in all BDD step-sizes. Moreover, increasing the BDD step-sizes significantly increased ROS at the ostial SB as treated by rISBD and SCD in the ostial SB as treated by rISBD or cIKBD. Conclusions: SIKBD was shown to be essential and superior to rISBD or cIKBD, resulting in better bifurcated stent expansion and coverage when using MCS.
文摘Kissing molars (KMs), first reported by Van Hoof in 1973, refer to molars with occlusal surfaces that contact each other in a single follicular space while their roots extend in opposite directions. This is a case of a 20-year-old male who presented with complaints of right mandibular molar pain with cold water contact and occlusion. Panoramic and cone-beam computed tomography (CBCT) images revealed impaction of the right mandibular third and fourth molars, with the occlusal surfaces contacting each other while the roots extended in opposite directions. KMs are classified according to the impaction of the mandibular first and second molars (Class I), second and third molars (Class II), and third and fourth molars (Class III). Our patient was considered Class III. Given the patient’s preference for surgical treatment, successful teeth extraction and extirpation were performed under intravenous sedation. The patient’s postoperative course was unremarkable. We describe a case of KMs Class III with a cystic variant assessed by panoramic and CBCT images. We additionally review all KMs Class III reported in the literature.
文摘Kissing bonds are defects in the adhesive bonds with intimate contact of touching surface but considerably lowered shear strength. Their detection specifically in the aerospace area is so not satisfactory. Usually, kissing bonds are inconspicuous in ultrasonic C-scans. However, the determination of attributes in the time domain and the frequency domain of an ultrasound signal provides the opportunity to derive a pattern for bonded area. Deviations from the pattern found in inconspicuous bonding areas indicate kissing bonds. The survey described here deals with the manufacturing of adhesively joint samples that purposefully include kissing bonds, as well as potential solutions for detecting them through ultrasonic testing combined with pattern recognition. The properties of the epoxy-based adhesive were varied by changing the mixing ratios between resin and hardener. Samples with a mixing ratio far apart from the manufacturer’s recommendation with an inconspicuous appearance in a C-scan, but low shear strength values were taken for further evaluation. After a definition and learning phase, a 100 percent hit rate to separate good bondings from kissing bonds could be derived in a blind test. The discriminating feature found is due to the frequency shift between good and kissing bonds as well as the relative amplitude of the second peak.
文摘Background The mechanisms responsible for the occurrence of a kissing unsatisfied （KUS） result after classical crush stenting remain unclear. The present study aimed at analyzing the mechanisms and clinical significance of KUS. Methods Two hundred and thirteen patients with true bifurcation lesions treated with classical crush stenting and final kissing balloon inflation （FKBI） were assigned to upper, middle, and lower groups according to the position of the side branch re-wiring assessed by visual estimation, quantitative coronary analysis （QCA） and intravascular ultrasound （IVUS）. Angiographic follow-up was indexed at 12 months. Results The upper group was characterized by a larger bifurcation angle of 55.53°±25.25° （P=0,030） and a longer procedural time （42.43±23.92） minutes （P=0.015）. The overall rate of KUS by visual estimation was 10.48%, with 5.4% in the upper group, 3.9% in middle group, and 36.1% in lower group （P 〈0.001）. For the diagnosis of KUS, visual inspection demonstrated a good correlation with both QCA and IVUS. Smaller stent diameter was the main reason for KUS in the upper group, while extra-stent side wire location, or re-wire in a low position was the main mechanism attributed to KUS in the lower group. The Lower group had more restenosis, with most restenotic lesions at a lower position of the side branch ostium. KUS （HR 1.652, 95% Cl 1.332-2.088, P 〈0.001） and re-wiring position （HR 2.341, 95% Cl 1.780-4.329, P 〈0.001） were two independent predictors of side branch restenosis. Re-wiring position （OR 0.458, 95%C/0.336-0.874, P=0.001） and side stent expansion （OR 3.122, 95%C/2.883-5.061, P=0.014） were factors predicting the findings of KUS. Conclusions Side wire outside side stents resulted in more KUS and restenosis. Different restenotic lesion types reflected individual mechanisms contributing to the development of plaque proliferation.
文摘Background Fractional flow reserve （FFR）-guided percutaneous coronary intervention （PCI） is associated with fewer unfavorable events. However, the hemodynamic change in FFR after different stenting approaches for bifurcation lesions is still not fully studied. The aim of this study was to analyze the hemodynamic changes in FFR after double kissing （DK） crush and provisional side branch （SB） stenting （PS） for true coronary bifurcation lesions. Methods Seventy-five patients with true bifurcated lesions were randomly divided into DK （n=38） and PS （n=37） groups. Additional SB stenting in the PS group was required if there was any pinched SB ostium 〉70% stenosis, or ≥ type B dissection, or TIMI flow 〈grade 3. FFR at hyperemia in the main vessel （MV） and SB was measured prior- and post-stenting, and at 8 months follow-up. Results Baseline clinical, angiographic and lesion characteristics were matched well between the two groups, with the exception of the final kissing balloon inflation （FKBI, 100.0% in the DK vs. 83.8% in the PS group, P 〈0.001）. Baseline FFR was comparable between the DK and the PS groups, however, the acute gain and late loss of SB FFR at 8-month follow-up in the DK group were 0.18±0.15 and -0.06±0.11, compared to 0.12±0.18 （P=0.044） and -0.002±0.07 （P=-0.037） in the PS group, respectively. MV FFR post-stenting 〉0.94 was seen in about 40% of patients. There was no significant difference in the clinical events at 1-year follow-up between the two groups. Conclusions DK crush was associated with improved acute gain and late loss of SB FFR. The lower rate of FFR 〉0.94 after stenting underscored the further improvement of stentinq quality.
文摘Standards for treating bifurcation lesions are crucial due to poor outcomes by percutaneous implantation of either bare metal stents or drug-eluting stents, even with several modified double-stent techniques including ＂T＂, ＂V＂, ＂Y＂, ＂culotte＂ and ＂simultaneous kissing stents （SKS）＂. Understanding the drawbacks in classical crush techniques, we proposed a novel double kissing （DK） crush technique being testified in our previous serial studies]＇2 The results from these randomized and pilot studies are describing a fantastic story---DK crush technique, by final kissing balloon inflation （FKBI） in 100% of lesions and high quality of kissing as assessed by both angiography and intravascular ultrasound, significantly improved the clinical outcome at a relative short-term follow-up. However, whether the advantage of the DK crush technique was sustained or not at a long-term remains unclear. The present study aimed to extend clinical follow-up and verify the differences between DK and classic crush techniques.
文摘Double kissing(DK)crush stenting for coronary bifurcation lesions has gain popularity worldwide because of its superior randomized studies data and excellent clinical outcomes.This review evaluates all DK crush clinical trials and studies.It also reveals the contemporary technique steps by steps as well as the trouble shooting with illustrated clinical scenarios.Among all the available evidence,the DK crush technique is superior when compared to the provisional stenting technique for complex bifurcation lesion.DK crush stenting provides the best evidence-based approach to complex bifurcation lesions especially the left main coronary artery bifurcation lesions.Future direction of how to make this DK crush technique better is also proposed.
