国产雷帕霉素洗脱支架介入治疗冠状动脉无保护左主干病变的疗效分析

目的观察国产雷帕霉素洗脱支架（FirebirdTM）介入治疗冠状动脉无保护左主干严重狭窄病变的疗效。方法对2004年1月—2008年12月住院的冠心病无保护左主干病变患者36例,行经皮冠状动脉介入治疗置入FirebirdTM支架,观察住院期间和出院后心脏事件发生率。结果在左主干狭窄36例中,左主干开口狭窄16例,体部狭窄7例,末端分叉病变13例。置入FirebirdTM支架均获得成功,无死亡病例。随访6~9个月1例发生再狭窄,均未发生亚急性或延迟性支架内血栓形成,无严重不良心血管事件发生。结论 FirebirdTM支架对冠心病无保护左主干严重狭窄病变患者近期疗效明显,能减少不良心血管事件发生。     

无保护左主干病变支架介入治疗后冠状动脉造影随访结果分析

目的观察无保护左主干病变,应用药物洗脱支架介入治疗后冠状动脉造影随访结果,并分析其影响因素。方法选择无保护左主干病变患者150例,其中48例在平均(10.0±7.5)个月进行了冠状动脉造影复查,根据冠状动脉造影显示有无狭窄分为:再狭窄组12例和无再狭窄组36例。结果与无再狭窄组比较,再狭窄组患者随访时最小管腔直径明显减小[(2.7±1.0)mm vs (3.5±0.4)mm,P=0.0001]、直径狭窄率明显升高[(31.4±26.4)% vs (8.3±5.3)%,P=0.0000]、晚期管腔丢失明显升高[(0.8±0.7)mm vs (0.2±0.3)mm,P=0.0000];双支架置入术的再狭窄率明显高于单支架置入术[(75.0% vs 13.9%),P=0.0011]。结论左主干远端分叉病变双支架置入术的疗效较差,冠状动脉旁路移植术应作为首选。     

无保护左主干病变患者经皮介入治疗的即刻及远期疗效分析

目的探讨无保护左主干病变患者经皮冠状动脉介入治疗(PCI)的近、远期疗效。方法解放军总医院2001年12月~2006年8月接受PCI的77例左主干病变的病例资料,2006年8月对上述患者进行随访,包括造影及电话随访。结果即刻成功率100%,无严重术中并发症,住院期间无死亡。术后随访0.5~54(12.95±10.31)个月,其中1例术后6个月行冠状动脉CT检查,支架内无狭窄;20例患者进行了冠状动脉造影检查,1例术后30天出现支架内亚急性血栓;10例分别在1~12个月造影时显示支架内再狭窄,其中4例发生在左主干支架内,其余再狭窄均发生在分叉远端,并分别进行了处理。其余患者进行了电话随访,1例复发心绞痛,接受药物治疗。结论对经过选择的无保护左主干病变患者进行支架置入是可行和安全的,并有良好的近、远期疗效。     

无保护左主干病变介入治疗后冠状动脉造影随访结果分析

目的探讨左主干病变裸支架治疗后再狭窄的可能原因。方法回顾性分析自1997年到2004年间行无保护左主干病变介入治疗并进行冠状动脉造影随访的18例患者的病变情况及其远期疗效。结果(1)9例双支架置入患者中,药物支架V型支架术的6例患者中有4例发生了再狭窄,再狭窄均发生在前降支和回旋支血管开口处;裸支架T支架术的2例患者发生了再狭窄,其中1例弥漫性再狭窄,另外1例发生了回旋支开口的再狭窄。(2)9例置入单个支架的患者中,5例患者支架跨过了回旋支开口,即采取了Cross-over技术,复查时只有1例左主干支架发生了再狭窄;3例左主干体部支架的患者中1例发生了弥漫性再狭窄。(3)对两例V支架的患者进行了血管内超声检查,发现在开口处没有完全膨胀,亦没有完全贴壁。结论(1)左主干病变介入治疗(特别是双支架置入方法)的再狭窄率很高。(2)在左主干分叉病变治疗中,支架跨过回旋支患者的远期预后良好,即支架可以安全地跨过回旋支。     

经皮冠状动脉无保护左主干分叉病变支架术28例分析

目的评价经皮冠状动脉介入术（PCI）治疗无保护左主干分叉病变的近远期疗效。方法回顾性分析我院无保护左主干分叉病变择期行PCI的28例冠心病患者的临床资料,全部置入药物洗脱支架,置入单支架12例,双支架16例。术后每2周或1个月门诊复查1次,8～12个月行冠状动脉造影复查。结果 28例PCI均取得成功,16例置入双支架的患者均成功进行球囊对吻扩张。所有病例术后达TIMI3级血流,住院期间无严重不良心脏事件,术后随访20～30个月,6个月内有4例再次出现心绞痛症状,冠状动脉造影复查显示支架内再狭窄3例（10.71%）,随访期内死亡1例。结论经选择的无保护左主干分叉病变PCI即刻成功率高,有较好的近、远期疗效。     

应用药物球囊与药物洗脱支架治疗左主干再狭窄分叉病变的对比研究

目的 对比应用药物球囊(DCB)血管成形术与再次植入药物洗脱支架(DES)治疗左主干再狭窄分叉病变对患者的长期影响.方法 回顾性纳入2014年10月-2018年10月在天津市胸科医院因左主干再狭窄分叉病变行介入治疗的患者48例,其中DCB组24例,DES组24例,术前、术后均行冠状动脉造影定量分析,39例(81.3％)...     

不稳定型心绞痛无保护左主干病变支架术后随访研究

目的　探讨冠状动脉内支架治疗无保护左主干病变 (LMD)的安全性及有效性。方法　2 7例LMD经球囊预扩张后置入支架。术后 6和 12个月行冠状动脉造影随访。结果　左主干开口病变 12例、体部 4例、末端 6例 (累及分叉开口 6例、单纯末端 1例 ) ,自开口到体部均狭窄者 5例 (含自开口处就完全闭塞 1例 )。术后 12个月时 ,左心室射血分数从 4 9 8%增加到 5 6 3% (P <0 0 5 )。球囊扩张时 2 0例 ( 6 2 % )出现显著心率减慢和血压下降。共置入 2 8枚支架 ,其中左主干内 2 7枚 ,主干内支架直径 ( 3 90± 0 4 7)mm、长度 ( 12 5 4± 3 95 )mm。全部患者均完成 12个月的临床随访 ,19例 ( 70 % )患者接受 6个月时冠状动脉造影 ,3例支架内再狭窄 ( 15 % ) ,其中 2例接受冠状动脉旁路术 ,1例行血管内放射治疗 ;术后 12个月时 15例 ( 5 5 % )行冠状动脉造影随访 ,1例再狭窄行冠状动脉旁路术 ,因此术后 12个月内累积再狭窄率为 2 1%。 4例再狭窄患者中 ,3例为末端病变 ( 75 % ) ,1例为开口病变( 2 5 % )。结论　冠状动脉内支架治疗LMD疗效可靠 ,冠状动脉造影随访可及时发现再狭窄。左主干末端病变再狭窄率显著。     

药物洗脱支架治疗冠脉无保护左主干病变的近中期疗效

目的：评价药物洗脱支架治疗冠脉无保护左主干病变的临床疗效。方法：回顾性分析2009年1月～2011年1月完成的65例无保护左主干病变药物洗脱支架置入术患者的临床资料。结果：65例无保护左主干病变患者全部成功置入支架,住院期间无主要心血管事件发生;术后6个月冠脉造影随访28例（43.1%）,其中2例发生再狭窄,再狭窄率7.1%;3年电话随访54例（83.1%）,其中8例患者心绞痛复发（14.8%）;2例（3.7%）行冠状动脉旁路移植术,余均无症状生存,3年生存率为100%。结论：药物洗脱支架治疗经选择的冠脉无保护左主干病变是安全可行的,有较理想的近期和中期疗效。     

国产雷帕霉素洗脱支架治疗冠状动脉左主干病变

目的 观察雷帕霉素洗脱支架（Firebird^TM）介入治疗冠心病冠状动脉左主干病变的临床疗效。方法 对2005年8月-2006年10月住院的冠心病主干病变患者18例,行经皮冠状动脉介入治疗植入Firebird^TM支架,术后随访观察心脏事件发生率。结果 在左主干狭窄18例中,开13狭窄2例,干段狭窄2例,分叉部狭窄14例。植入Firebird^TM支架均获得成功,住院期间死亡1例。随访（6±3）个月发现复发心绞痛2例。结论 Firebird^TM支架对冠心病左主干病变患者近期疗效明显,能减少不良心脏事件发生率。     

双国产药物洗脱支架治疗左主干Ⅳ型分叉病变的疗效及随访结果

目的探讨应用改良Crush技术置入双国产药物洗脱支架（DES）处理左主干Ⅳ型分叉病变的安全性和临床疗效。方法应用改良Crush技术处理患者左主干Ⅳ型分叉病变29例。即在左主干及分支中置入药物洗脱支架,主支支架部分压住分支支架2~3mm,并行对吻扩张。记录手术操作及住院相关资料,定量冠状动脉造影记录术前、术后及随访时冠状动脉资料。结果所有病例均以改良Crush术式完成国产DES置入术,并全部完成最终对吻扩张。平均操作时间36·2±9·4min,平均透视时间为18·3±3·5min。其中13例经桡动脉路径完成,16例经股动脉完成;17例（58·6%）患者为前降支开口病变,12例（44·8%）行球囊预扩张;23例置入PARTNER支架,6例置入EXCEL支架;主支支架直径为3·76±0·25mm,长度为18·19±3·40mm。本组病例无严重介入相关并发症发生。平均临床随访时间为14·2±5·2个月,无猝死、非致死性心肌梗死发生,无再狭窄及靶病变血运重建。14例（48·3%）进行冠状动脉造影随访,平均随访时间为11·5±2·7个月。定量冠状动脉造影显示基线开口狭窄率为78·4%,平均靶病变长度为13·20±4·71mm,主支支架即刻获得管腔为1·92±0·22mm,晚期管腔丢失为0·06±0·10mm,无主支支架再狭窄发生;边支晚期管腔丢失为0·21±0·12mm,无再狭窄发生;左主干晚期管腔丢失为0·09±0·12mm。结论Crush技术置入双国产DES处理左主干Ⅳ型分叉病变手术成功率高,具有很好的安全性和临床远期疗效。     

Percutaneous coronary intervention for unprotected left main coronary artery stenosis

Hemodynamically significant left main coronary artery stenosis (LMCA) is found in around 4% of diagnostic coronary angiograms and is known as unprotected LMCA stenosis if the left coronary artery and left circumflex artery has no previous patent grafts. Previous randomized studies have demonstrated a significant reduction in mortality when revascularization by coronary artery bypass graft (CABG) surgery was undertaken compared with medical treatment. Therefore, current practice guidelines do not recommend percutaneous coronary intervention (PCI) for such a lesion because of the proven benefit of surgery and high rates of restenosis with the use of bare metal stents. However, with the advent of drug-eluting stents (DES), the long term outcomes of PCI with DES to treat unprotected LMCA stenoses have been acceptable. Therefore, apart from the current guidelines, PCI for treatment of unprotected LMCA stenosis is often undertaken in individuals who are at a very high risk of CABG or refuse to undergo a sternotomy. Future randomized studies comparing CABG vs PCI using DES for treatment of unprotected LMCA stenosis would be a great advance in clinical knowledge for the adoption of appropriate treatment.     

无保护左主干末端病变接受经皮冠状动脉介入治疗或冠状动脉旁路移植术远期效果评价

目的研究不同血管重建方式对无保护左主干（ULMCA）末端病变患者治疗的效果及预后意义。方法连续收录冠状动脉造影明确诊断为ULMCA末端病变的222例患者临床资料,其中106例置入药物洗脱支架（PCI组）,116例行冠状动脉旁路移植手术（CABG组）,观察两组患者在12个月及3年发生全因死亡、非致死性心肌梗死、靶血管重建和主要不良心脏事件发生率,研究不同血管重建方式对ULMCA末端病变治疗效果的影响。结果两组患者在12个月期间,主要终点事件如全因死亡、非致死性心肌梗死差别无统计学意义（分别为：χ2=1.05,P=0.32和χ2=1.04,P=0.38）,靶血管重建以及主要不良心脏事件发生率差异有统计学意义（分别为：χ2=5.45,P=0.02和χ2=6.63,P=0.01）。累积3年随访,PCI组与CABG组相比全因死亡率降低33%（10.38%比12.07%,χ2=0.47,P=0.45）,但非致死性心肌梗死是后者的1.87倍（2.1%比0,χ2=1.04,P=0.38）。PCI组靶血管重建率是CABG组4.17倍（20.76%比8.62%,χ2=6.63,P〈0.01）,而主要不良心脏事件两组相比差异有统计学意义（33.02%比20.68%,χ2=4.78,P=0.03）。结论 ULMCA末端病变采用PCI或CABG进行血管重建是安全有效的。对解剖结构适合PCI且患者拒绝或不宜行CABG的ULMCA末端病变患者来说,药物洗脱支架PCI术是一种可以选择的替代治疗方案。     

Endeavor支架治疗冠心病左主干病变的临床疗效观察

目的:评价Endeavor支架治疗选择性冠心病无保护左主干病变的安全性和有效性。方法:2006年9月至2008年1月,共84例经选择的冠心病无保护左主干病变患者,年龄37～78岁,平均(59.6±14)岁,其中男性60例(71%),有糖尿病者24(29%),左主干狭窄均≥75%,均接受Endeavor支架治疗,随访12个月,随访终点指标:不良心脏事件(MACE)率、靶血管重建(TVR)率,支架血栓发生率。结果:84例患者介入治疗均获得成功,共植入Endeavor支架148枚。其中左主干开口部狭窄8例(10.4%,8/84),体部狭窄12例(12.5%,12/84),远端分叉部位狭窄64例(76.2%,64/84)。64例远端分叉部位狭窄患者均使用分步Crush技术处理主支和边支。所有患者治疗后临床症状明显缓解或消失,12个月MACE率为7.1%,TVR率为7.1%,支架血栓发生率为0%。结论:Endeavor支架介入治疗冠心病无保护左主干病变安全有效,近期效果良好。     

Effectiveness of drug-eluting stent implantation for patients with unprotected left main coronary artery stenosis

This study was aimed to evaluate outcomes of patients with unprotected left main coronary artery (LMCA) stenosis who were treated with drug-eluting stents. Sixty-three consecutive patients with unprotected LMCA stenosis were treated with sirolimus-eluting stents in 52 (83%) patients and paclitaxel-eluting stents in 11 (17%) patients, in whom percutaneous intervention was considered the sole alternative because of high surgical risk and/or patient preference. Urgent percutaneous coronary intervention within 24 hours after angiography was performed in 6 (10%) patients. The patients were predominantly at high surgical risk with 35 (56%) having EuroSCORE >6 and 39 (62%) having Parsonnet score >15. Involvement of the distal LMCA was observed in 46 (73%) patients. Procedural success was achieved in all patients. Intravascular ultrasound was used in 51 (81%) patients. Single-stenting strategy was adopted in 36 (78%) patients with bifurcation stenosis. There were no death, Q-wave myocardial infarction, stent thrombosis, or urgent repeat revascularization events during hospitalization. Over a mean follow-up of 11.7 +/- 7.7 months, 18 (29%) patients experienced major adverse cardiac events, including 3 (5%) deaths, 7 (11%) myocardial infarctions, and 10 (16%) target lesion revascularizations. Stent thrombosis developed in 1 (0.6%) patient at 35 days after the procedure. Bifurcation involvement was an independent predictor of major adverse cardiac events by multivariate analysis (hazard ratio 12.90, 95% confidence interval 1.36 to 122.45, p = 0.0259). In conclusion, drug-eluting stent placement for unprotected LMCA stenosis may be a feasible therapeutic alternative in patients at high surgical risk. However, bifurcation stenosis remains a significant predictor of unfavorable clinical outcome.     

Angioplasty of the unprotected left main coronary artery stenosis with standby cardiopulmonary support--a case report

Stenosis of the unprotected left main coronary artery (LMCA) is a classical indication for coronary artery bypass graft surgery (CABG). Percutaneous coronary intervention (PCI) of LMCA may be an alternative to surgical treatment if atherosclerosis of distal segments is very advanced. The periprocedural risk is high, especially if comorbidities are present. However, long-term results remain unclear. The ongoing Syntax trial will clarify whether angioplasty of LMCA with drug-eluting stents can be equivalent to CABG. We present a case of a patient with occluded right coronary artery, severe stenoses of the LMCA, left anterior descending artery and left circumflex artery, and poor left ventricular ejection fraction in whom PCI for stenosis of unprotected LMCA with standby cardiopulmonary support was performed.     

Results of percutaneous coronary intervention of the unprotected left main coronary artery in 143 patients and comparison of 30-day mortality to results of coronary artery bypass grafting

Percutaneous coronary intervention (PCI) of the unprotected left main coronary artery (LMCA) is controversial. In 143 patients who underwent PCI of the unprotected LMCA, 30-day mortality was compared with predicted cumulative risk-adjusted perioperative surgical mortality based on logistic European System for Cardiac Operative Risk Evaluation. One-year clinical follow-up was completed in all patients. The overall major adverse cardiac event rate at 1 year was 34.3%, reflecting the high-risk profile of the patient population. Twelve patients (8%) experienced an acute myocardial infarction and 16 (11%) underwent target lesion revascularization. In 31 patients (22%) who died during the first year, median logistic European System for Cardiac Operative Risk Evaluation was 30%. Calculated RRs showed significantly lower 30-day mortality using PCI compared with predicted surgical mortality (RR 0.54, 95% confidence interval 0.31 to 0.86). Angiographic follow-up in 90 of the 118 patients alive at 6 months showed binary restenosis of 6% in patients treated with drug-eluting stents versus 29% in patients receiving bare-metal stents (p < or =0.01). In conclusion, PCI for unprotected LMCA disease was associated with acceptable short- and medium-term outcomes in patients at low to intermediate risk of bypass surgery. Mortality remains high in very high-risk patients unsuitable for surgery. However, in selected indications, PCI of the LMCA can offer an alternative to surgery, especially when using drug-eluting stents.     

Sirolimus-eluting stent for in-stent restenosis of left main coronary artery in takayasu arteritis.

A 53-year-old woman with Takayasu arteritis was admitted to hospital because of worsening exertional angina. Coronary angiography revealed 90% ostial stenosis in the left main coronary artery (LMCA), which also involved the bifurcation of the relatively short LMCA. Because the patient refused coronary bypass surgery, she underwent percutaneous coronary intervention (PCI) and the stenosis was successfully dilated. However, the exertional angina recurred a few months later and again after the second PCI. Finally, a sirolimus-eluting stent was deployed in the in-stent restenotic lesion. The patient has been free from angina pectoris for 6 months after the last PCI and follow-up coronary angiography indicated no restenosis in the LMCA.     

Long-term effect of stenting in unprotected left main coronary artery disease in the elderly

Objective To evaluate the feasibility, safety and efficacy of percutaneous stent implantation for treating left main coronary artery (LMCA) stenosis. Methods Consecutive patients with unprotected left main coronary artery disease treated by stent-based percutaneous intervention (PCI) at 6 medical centers in China were enrolled. Procedural data and clinical outcomes were obtained from all patients. Results From January 2001 to December 2004, 138 patients (79 males and 59 females; mean age: 69.7±5.8 years) underwent PCI for LMCA stenosis. Bare metal stents (BMS) were implanted in 51 patients with non-bifurcational lesions and in 5 patients with bifurcational lesions from January of 2001 to June of 2003 (BMS group);. drug eluting stents (DES) were used unselectively to cover both bifurcational and non-bifurcational lesions in 86 patients from July of 2003 to December of 2004 (DES group). Procedural success rate of the 138 cases was 98% (135/138). One patient (0.7%) with bifurcation lesion who was treated with DES died from severe heart failure 2 weeks after the procedure. During a mean follow up period of 21.3±5.6 months, one patient died from renal failure, one from sudden cardiac death, 4 underwent target lesion revascularization (TLR) in the BMS group, which all occurred in patients with bifurcational lesions; whereas in the DES group no deaths occurred and only one patient with bifurcational lesion had TLR. Conclusions (1) PCI is feasible and relatively safe to treat unprotected left main coronary artery disease in elderly patients at medical centers with experienced professionals. (2) BMS and DES have similar immediate and long-term efficacy in the treatment of ostium and shaft lesions of the LMCA. (3) DES are strongly suggested in the therapy of distal bifurcation lesion of unprotected LMCA.     

Stenting of Unprotected Left Main Coronary Artery Stenoses: Immediate and Late Outcomes

Objectives. We examined the immediate and long-term outcomes after stenting of unprotected left main coronary artery (LMCA) stenoses in patients with normal left ventricular (LV) function.Background. Left main coronary artery disease is regarded as an absolute contraindication for coronary angioplasty. Recently, several reports on protected or unprotected LMCA stenting, or both, suggested the possibility of percutaneous intervention for this prohibited area.Methods. Forty-two consecutive patients with unprotected LMCA stenoses and normal LV function were treated with stents. The post-stent antithrombotic regimens were aspirin and ticlopidine; 14 patients also received warfarin. Patients were followed very closely with monthly telephone interviews and follow-up angiography at 6 months.Results. The procedural success rate was 100%, with no episodes of subacute thrombosis regardless of anticoagulation regimen. Six-month follow-up angiography was performed in 32 of 34 eligible patients. Angiographic restenosis occurred in seven patients (22%, 95% confidence interval 7% to 37%); five patients subsequently underwent elective coronary artery bypass graft surgery (CABG), and two patients were treated with rotational atherectomy plus adjunct balloon angioplasty. The only death occurred 2 days after elective CABG for treatment of in-stent restenosis. The other patients (without angiographic follow-up) remain asymptomatic.Conclusions. Stenting of unprotected LMCA stenoses may be a safe and effective alternative to CABG in carefully selected patients with normal LV function. Further studies in larger patient populations are needed to assess late outcome.     

Comparison between coronary angioplasty and coronary artery bypass surgery for the treatment of unprotected left main coronary artery stenosis (the Bologna Registry)

Although great interest exists in the relative efficacy of coronary artery bypass grafting (CABG) versus percutaneous coronary intervention (PCI) for the treatment of unprotected left main coronary artery stenosis, data comparing the 2 strategies are scant. Furthermore, no comparison has ever been performed between CABG and drug-eluting stents in this setting. From January 2002 to June 2005, 154 patients with unprotected left main coronary artery stenosis underwent CABG and 157 underwent PCI. Ninety-four patients received a drug-eluting stent in the left main artery. After a median follow-up of 430 days, the rate of mortality, acute myocardial infarction, and target lesion revascularization was 12.3%, 4.5%, and 2.6%, respectively, in the CABG group and 13.4%, 8.3%, and 25.5%, respectively, in the PCI group (death and myocardial infarction p = NS, target lesion revascularization p = 0.0001). Although patients treated with drug-eluting stents had a 25% relative risk reduction in the rate of death, myocardial infarction, and target lesion revascularization compared with patients treated with bare stents, event-free survival was still better for patients treated with CABG. In the multivariate analysis, age >or=70 years, New York Heart Association classes III and IV, acute coronary syndromes, and peripheral vascular disease were the only independent predictors of mortality. In conclusion, our results have indicated that at long-term follow-up no difference exists in the rate of mortality and myocardial infarction between PCI and CABG for the treatment of unprotected left main coronary artery stenosis. However, the rate of target lesion revascularization was higher in the PCI group.