【摘要】 目的探讨应用双药物洗脱支架(DES)治疗分叉病变的临床疗效。方法选择分支开口有严重狭窄且分支口径≥2.50mm的分叉病变患者为本研究的入选对象。2003年10月至2005年6月共入选应用双DES治疗分叉病变的患者112例,113处病变。分叉病变的类型为前降支/对角支62例(54.9%),左冠状动脉主干分叉病变32例(28.3%),回旋支/钝缘支18例(15.9%),右冠状动脉远端分叉病变1例。113处分叉病变中采用Crush技术64处,“T”型支架置入27处;改良“Y”型支架置入11处;对吻支架置入5处;“V”型支架置入和Culotte技术置入各3处。结果入选112例患者113处分叉病变中(226处病变)使用Cypher或CypherselectDES91个,TAXUSDES74个,FirebirdDES67个。64处分叉病变采用Crush技术置入双支架后60处(93.7%)完成了最后的对吻球囊扩张技术。手术成功率为100%。住院期间1例发生亚急性血栓致急性心肌梗死(AMI),再次介入治疗成功。住院期间心脏事件发生率(MACE,包括死亡、AMI、再次血管重建)为0.89%(1/112)。112例均完成了9个月的临床随访,无死亡发生,1例发生AMI由晚期血栓形成所致。48例完成了9个月的冠状动脉造影随访(42.9%),8例发生了支架内再狭窄,其中1例进行了冠状动脉旁路移植术,5例再次行介入治疗,总再狭窄发生率为16.7%(8/48)。随访期间MACE发生率为8.04%(9/112)。结论本研究结果显示对于分支口径≥2.5mm且口部有严重狭窄性病变的分叉病变,采用双DES治疗是安全的,近、远期临床疗效是满意的。与CypherDES相比较,TAXUSDES的再狭窄发生率有增加的趋势。更多还原

【Abstract】 Objective To evaluate the clinical outcomes of treating bifurcation lesions with two drug-eluting stent(DES)techniques.Methods From October 2003 to June 2005,112 patients with 113 bifurcation lesions with severe stenosis at the ostium of side branch and the diameter ≥2.50 mm were treated by two DES.Sixty-two of the bifurcation lesions were located in LAD/diagonal(54.9%),32 in distal left main coronary arteries(28.3%),18 in LCX/OM(15.9%)and 1 distal RCA(0.9%).Sixty-four lesions were treated with Crush technique,27 with “T-form” stent implanting technique,11 with modified “Y-form” stent implanting technique,5 with kissing technique,3 with “V-form” stent implanting technique and 3 with Culotte technique.Ninty-one Cypher or Cypher select DES stents,74 TAXUS DES stents,67 Firebird stents were used for 226 lesions.Final kissing balloon inflation was performed in 60 bifurcation lesions(93.7%)after 64 Crush stenting procedure.Results Success rate of PCI procedure for the bifurcation lesions was 100%.One patient developed subacute stent thrombosis and underwent successful urgent revascularization.In-hospital major adverse cardiac events(death,AMI,revascularization,MACE)rate was 0.89%(1/112).Nine months follow-up was made in all 112 patients and all patients were alive and MACE rate was 8.04%(9/112)with 1 AMI occurred during the follow-up period in 1 patient due to late thrombosis.Follow-up coronary angiography at 9 months was performed in 48 patients(42.9%)and evidenced 8 in-stent restenosis(16.7%)and 1 patient received CABG,re-PCI was performed in 5 patients.Conclusion Two DES technique for the treatment of bifurcation lesions is safe and effective and short-and long-term outcomes is satisfactory.更多还原