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冠脉搭桥术曾经被认为是左主干病变治疗的“金标准”,近年来经皮冠脉介入治疗也在该领域取得一些进展,一系列临床试验证实药物洗脱支架治疗左主干病变安全可行,但在左主干远端分叉病变还存在再狭窄率高的问题。就目前而言,对于有选择的左主干病变,药物洗脱支架是一种充满生机的治疗方法。 相似文献
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Kalpa De Silva PhD FRCP FACC Matthew E. Li Kam Wa BSc MRCP Tim Wells BSc FRCP Abdul Mozid MD FRCP Andrew Ladwiniec MD FRCP Brian G. Hynes MBBCh Ashish Kotecha FRCP Karim Ratib MRCP Sinjini Biswas PhD FRACP Nicolas Amabile MD PhD Pierre Deharo MD PhD Margaret McEntagart PhD FRCP James C. Spratt MD FRCP FESC FACC Franck Digne MD Meadhbh Hogg MBChB Jonathan A. Mailey FRCP Simon J. Walsh MD FRCP Sundeep S. Kalra PhD MRCP 《Catheterization and cardiovascular interventions》2023,102(7):1222-1228
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Pawel E. Buszman Piotr P. Buszman R. Stefan Kiesz Andrzej Bochenek Blazej Trela Magda Konkolewska David Wallace-Bradley Mirosław Wilczyński Iwona Banasiewicz-Szkróbka Ewa Peszek-Przybyla Marek Krol Marek Kondys Krzysztof Milewski Szymon Wiernek Marcin Dębiński Aleksander Żurakowski Jack L. Martin Michał Tendera 《Journal of the American College of Cardiology》2009
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Left main coronary artery (LMCA) thrombosis with acute myocardial infarction is an uncommon condition with an extremely high mortality. The small number of reported cases prevents the development of an evidence-based approach. Hence there are no clear-cut guidelines describing the best management approach for this condition. We describe our experience with six patients who presented with LMCA thrombosis and discuss the epidemiology, etiology and management options available for this high-risk subgroup. 相似文献
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Sungsoo Cho Tae Soo Kang Jung-Sun Kim Sung-Jin Hong Dong-Ho Shin Chul-Min Ahn Byeong-Keuk Kim Young-Guk Ko Donghoon Choi Young Bin Song Joo-Yong Hahn Seung-Hyuk Choi Hyeon-Cheol Gwon Myeong-Ki Hong Yansoo Jang 《JACC: Cardiovascular Interventions》2018,11(13):1247-1258
Objectives
This study sought to investigate the long-term clinical effects of stent generation and stent strategy for left main coronary artery (LMCA) bifurcation lesion treatment.Background
Limited data are available to assess long-term clinical outcomes after stenting, including use of current-generation drug-eluting stent (C-DES) for treatment of LMCA bifurcation lesions.Methods
A total of 1,353 patients who were recorded in 2 multicenter real-world registries were treated by either early-generation drug-eluting stent (E-DES) (n = 889) or C-DES (n = 464). Primary endpoint was major adverse cardiovascular events (MACE). MACE was defined as a composite of cardiac death or myocardial infarction, stent thrombosis, and target lesion revascularization rates during 3-year follow-up. The authors further performed propensity-score adjustment for clinical outcomes.Results
During 3-year follow-up, the overall MACE rate was 8.7%. Use of a 1-stent strategy resulted in better clinical outcomes than use of a 2-stent strategy (4.7% vs. 18.6%, hazard ratio [HR]: 3.71; 95% confidence interval [CI]: 2.55 to 5.39; p < 0.001). Use of C-DES resulted in a lower MACE rate compared with using E-DES (4.6% vs. 10.9%, HR: 0.55; 95% CI: 0.34 to 0.89; p = 0.014), especially for the 2-stent strategy. For patients with C-DES, the presence of chronic kidney disease and pre-intervention side branch diameter stenosis ≥50% were significant independent predictors of MACE.Conclusions
Intervention of LMCA bifurcation lesions using DES implantation demonstrated acceptable long-term clinical outcomes, especially in C-DES patients. Use of a 1-stent strategy resulted in better clinical benefits than using a 2-stent strategy. 相似文献14.
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冠状动脉旁路移植术一直被认为是治疗无保护左主干病变的金标准.近年来,由于经皮冠状动脉介入治疗技术及器械的迅速发展,特别是药物洗脱支架的广泛应用,使冠状动脉介入治疗术后由再狭窄导致的再次靶病变血运重建率明显降低,经皮冠状动脉介入治疗无保护左主干病变研究以及和冠状动脉旁路移植术疗效对比研究越来越多,并且显示药物洗脱支架对无保护左主干病变有良好的疗效,其安全性与冠状动脉旁路移植术相似,甚至在某些方面具有优势.现就近年来冠状动脉旁路移植术和冠状动脉介入治疗无保护左主干病变的研究进展做一综述,探讨在药物洗脱支架年代无保护左主干病变治疗策略的选择. 相似文献
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Allison C Morton Anjan Siotia Nadine D Arnold Peter Korgul John Bowles James Heppenstall Julian Gunn 《Catheterization and cardiovascular interventions》2007,69(2):209-215
BACKGROUND: While several endovascular techniques have been developed for treating arterial bifurcation lesions, there is, as yet, no single, widely accepted technique for treating left main stem (LMS) bifurcation lesions with stents. The simultaneous kissing stent (SCS) technique seems particularly suited for such lesions. The authors describe a consecutive cohort of patients with LMS bifurcation stenosis treated with this technique and present mechanistic insights from a porcine model. METHODS: Thirty consecutive patients with LMS bifurcation stenosis +/- multivessel disease were treated with SCS technique using paclitaxel-eluting stents. The technique involves simultaneous implantation of two stents (LMS-LAD and LMS-Cx) so that the proximal end of both stents lie at the same level in the body of LMS. Symptom status was recorded and follow-up angiography was performed. In addition, four pigs underwent SCS implantation of the LMS and were studied by direct examination, histology, and scanning electron microscopy. RESULTS: The patients' mean age was 63, 26 were elective and 19 were male. Paclitaxel-eluting stents (Taxus, Boston Scientific) were used. There was one in-hospital death in a highly unstable patient. At 6-month follow-up angiography, two patients required target lesion revascularization. At 13 +/- 3 month follow-up, the remaining patients remain well, with no other major adverse cardiac events. The animals all survived with patent stents. SEM demonstrated full re-endothelialization and histology showed a thin but complete neointima covering the stent struts. CONCLUSION: The SCS technique for treating LMS bifurcation disease with paclitaxel-eluting stents is safe and feasible. Medium term clinical and angiographic results are good. An endothelium and a thin neointima cover the metal struts. 相似文献
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Kensuke Takagi MD Alfonso Ielasi MD Sandeep Basavarajaiah MD Alaide Chieffo MD Joanne Shannon MD Cosmo Godino MD Tasuku Hasegawa MD Toru Naganuma MD Yusuke Fujino MD Azeem Latib MD Mauro Carlino MD Matteo Montorfano MD Sunao Nakamura MD Antonio Colombo MD 《Catheterization and cardiovascular interventions》2014,84(3):341-348
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Tae-Min Rhee Kyung Woo Park Chi-Hoon Kim Jeehoon Kang Jung-Kyu Han Han-Mo Yang Hyun-Jae Kang Bon-Kwon Koo Hyo-Soo Kim 《JACC: Cardiovascular Interventions》2018,11(24):2453-2463
Objectives
The aim of this study was to investigate clinical outcomes after left main coronary artery (LM) bifurcation percutaneous coronary intervention (PCI) and the impact of the duration of dual antiplatelet therapy (DAPT) according to treatment strategy.Background
There are limited data regarding the optimal PCI strategy for LM bifurcation lesions with new-generation drug-eluting stents.Methods
A patient-level pooled analysis of 5 nationwide multicenter registries was performed. Rates of target lesion failure, thrombotic adverse cardiovascular events, and their individual components at 3-year were analyzed. Subgroup analysis according to DAPT duration was performed.Results
From 13,172 patients undergoing PCI with new-generation drug-eluting stents, a total of 700 patients were treated for LM bifurcation lesions, 567 with a 1-stent strategy and 133 with a 2-stent strategy. Rates of target lesion failure and target lesion revascularization were higher in the 2-stent group, driven mainly by complex lesion profiles. Risks for thrombotic adverse cardiovascular events and its components were comparable between the 2 strategies. Subgroup analysis showed that risks for target lesion failure and thrombotic adverse cardiovascular events in the 2-stent group were significantly higher than in the 1-stent group in those with DAPT interruption <1 year, while they were similar in those receiving DAPT maintenance ≥1 year.Conclusions
Up to 20% of patients who underwent LM bifurcation PCI eventually required a 2-stent strategy, which was as safe as a 1-stent strategy with the use of new-generation drug-eluting stents. Careful pre-emptive case selection as well as prolonged DAPT may be necessary when considering a 2-stent strategy in LM PCI given its higher rate of repeat revascularization and lesion failure than the 1-stent approach. 相似文献19.
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Xiang Chen Xiaobo Li Jun-Jie Zhang Yaling Han Jing Kan Lianglong Chen Chunguang Qiu Teguh Santoso Chootopol Paiboon Tak W. Kwan Imad Sheiban Martin B. Leon Gregg W. Stone Shao-Liang Chen 《JACC: Cardiovascular Interventions》2019,12(19):1927-1937
ObjectivesThe present study aimed to investigate the difference in target lesion failure (TLF) at 3 years after double kissing (DK) crush stenting versus provisional stenting (PS) for unprotected left main distal bifurcation (UPLMb) lesions.BackgroundThe multicenter and randomized DKCRUSH-V (Double Kissing Crush versus Provisional Stenting for Left Main Distal Bifurcation Lesions: The DKCRUSH-V Randomized Trial) study showed fewer 1-year TLF after DK crush for UPLMb lesions compared with PS. The study reports the 3-year clinical outcome of the DKCRUSH-V study.MethodsA total of 482 patients with UPLMb lesions who were randomly assigned to either the DK crush group (DK group) or PS group in the DKCRUSH-V study were followed for 3 years. The primary endpoint was the occurrence of a TLF at 3 years. Stent thrombosis (ST) was the safety endpoint. Patients were classified by lesion’s complexity and NERS (New Risk Stratification) II or SYNTAX (Synergy Between Percutaneous Coronary Intervention With TAXUS and Cardiac Surgery) score.ResultsAt 3 years, TLF occurred in 41 (16.9%) patients in the PS group and in 20 (8.3%) patients in the DK group (p = 0.005), mainly driven by increased target vessel myocardial infarction (5.8% vs. 1.7%; p = 0.017) and target lesion revascularization (10.3% vs. 5.0%; p = 0.029). Definite or probable ST rate at 3 years was 4.1% in the PS group and 0.4% in the DK group (p = 0.006). Notably, DK crush was associated with a significant reduction in both primary and secondary endpoints for patients with complex lesions or at high risk.ConclusionsProvisional stenting for UPLMb lesions was associated with significantly increased rates of TLF and ST over 3 years of follow-up. Further randomized study is warranted to confirm the benefits of DK crush stenting for complex UPLMb lesions. (Double Kissing and Double Crush versus Provisional T Stenting Technique for the Treatment of Unprotected Distal Left Main True Bifurcation Lesions: A Randomized, International, Multi-center Clinical Trial; ChiCTR-TRC-11001213). 相似文献