单支架及双支架植入治疗冠状动脉分叉病变的临床疗效比较

目的 探讨冠状动脉分叉病变植入单支架或双支架后即刻疗效及对预后的影响.方法 选取88 例冠状动脉分叉病变患者为研究对象,将其分为:单支架植入组:主支植入药物涂层支架,对支架植入术后受影响的分支予球囊扩张;双支架植入组:应用Mini-Crush 技术对主支血管及分支血管分别植入药物涂层支架,比较两组患者支架植入术后即刻血管血流情况、术后6 个月及12 个月心血管事件、术后12 个月冠状动脉造影血管血流情况.结果 46 例患者成功行主支血管支架植入+必要时分支血管球囊扩张,42 例患者成功行双支架植入术,术后即刻造影两组患者主分支血管血流TIMI 3 级、主支血管残余狭窄＞30%差异无统计学意义(P ＞0.05),但双支架植入组术后即刻造影分支血管残余狭窄＞50%患者3 例,单支架植入组13 例(P ＝0.01),住院期间、术后6 个月两组心血管事件差异无统计学意义(P ＞0.05),术后12 个月单支架植入组心血管事件15 例,双支架植入组6 例(P ＝0.044),术后12 个月冠状动脉造影,两组患者主支血管血流TIMI 3 级、主支残余狭窄＞30%差异无统计学意义(P ＞0.05),但双支架植入组术后12 个月分支血管残余狭窄＞50% 7 例,TIMI 血流3 级27 例,单支架植入组分支血管残余狭窄＞50% 18 例,TIMI 血流3 级21 例(P ＜0.05).结论 对冠状动脉分叉病变,行双支架植入术能降低术后即刻、术后12 月分支血管狭窄率,减少术后12 月心血管事件,对冠状动脉分叉病变,双支架植入术优于单支架植入术.

Single stent versus double stents in treatment of bifurcatoin lesions of coronary

Objective To study the immediate effect and prognosis in bifurcatoin lesions of coronary after implanting single stent or double stents.Methods Eighty-eight patients with bifurcatoin lesions of coronary were randomly divided into one stent treatment group （n=46） and double stents treatment group （n=42）.The patients of single stent treatment group were treated by implanting single stent on the main branch coronary if request percutaneous transluminal coronary angioplasty（PTCA） were practiced on the bifurcation coronary.The patients of double stents treatment group were treated by implanting stents on the main coronary and bifurcation coronary.The coronary flow of immediate and 12 month after PCI and cardiovascular events of 6 month and 12 month after PCI were studied and compared.Results Fourty-six patients with bifurcation lesions were successfully treated by implanting single stent on the main branch coronary and PTCA on the bifurcation coronary.Fourty-two patients with bifurcation lesions were successfully treated by implanting stents on the main coronary and bifurcation coronary.There were no significant difference between two groups both the rate of TIMI grade 3 and more than 30 percent coronary stenosis on the main branch after immediate and after 12 month coronary angiography（P〉0.05）,more than 50 percent coronary stenosis of bifurcation coronary were in thirteen cases in single stent group and only 3 cases in double stents group（P=0.01）.There were no significant difference between two groups on the CVD during hospital and after 6 month of PCI （P〉0.05）.The CVD was in 15 cases in single stent group and only 6 cases on double stents group after 12 month （P=0.044）.The coronary stenosis exceed 50 percent of bifurcation coronary were 18 cases on single stent group and only seven cases in double stents group after 12 month coronary angiography（P=0.013）.The rate of TIMI grade 3 were 21 cases in single stent group and 27 cases in double stents group after 12month coronary angiography（P=0.034）.Conclusions The patients with bifurcation lesions of coronary treated with double stents can decrease the incidence of restenosis on bifurcation coronary after moment and twelvemonth coronary angiography and CVD after 12 month.The double stents in the treatment of the patients with bifurcation lesions of coronary should preferentially be elected.