拘禁球囊技术在冠状动脉分叉病变中应用的临床疗效观察

目的总结拘禁球囊技术治疗冠状动脉分叉病变的经验,并分析其安全性和疗效。方法选择2014年6月至2016年4月在南京医科大学附属南京医院行冠状动脉造影证实为真性分叉病变的患者50例,按随机数字表法分为两组:拘禁导丝组(25例)和拘禁球囊组(25例),比较两组患者分支夹层或闭塞发生率、置入支架数量、手术时间和造影剂用量等,并对主要不良心血管事件(MACE)、病变血管再狭窄情况进行随访,对其有效性和安全性进行评价。结果拘禁导丝组4例发生分支闭塞或夹层,共置入5枚支架,拘禁球囊组1例发生分支夹层,置入1枚支架,且拘禁导丝组的手术时间和造影剂用量均明显高于拘禁球囊组,差异有统计学意义[(84.5±13.4)min比(53.2±9.8)min,t=2.84,P=0.009;(135.3±12.5)ml比(106.8±11.7)ml,t=8.33,P=0.001]。术后1年,复查冠状动脉造影并行冠状动脉造影定量分析检查,两组主支和边支血管管腔丢失差异均无统计学意义(均为P0.05)。随访期间,拘禁球囊组有1例患者因心力衰竭发作入院,拘禁导丝组有1例患者因心绞痛再发入院,并行靶血管血运重建治疗,余无其他MACE事件。结论拘禁球囊技术是一种治疗冠状动脉分叉病变的有效方法,与传统保护导丝比较,拘禁球囊技术能够有效防止重要分支闭塞,且手术时间和曝光时间短、造影剂用量少,是一种安全、可行的方法。     

拘禁球囊技术应用于真性分叉病变V-RESOLVE高危病人的疗效观察

目的:通过对真性分叉病变单支架策略中分支的不同处理方式进行分组,对比两种术式在手术即刻和近远期的安全性和有效性,探讨更佳的边支保护技术,并为分叉病变经皮冠状动脉介入治疗(PCI)积累经验。方法:将我院2019年3月—2020年2月行冠状动脉造影确诊为真性分叉病变并行单支架策略病人共164例随机分为拘禁球囊技术(JBT)组和边支导丝保护技术(JWT)组,并收集两组病人的一般资料、临床生化指标、PCI相关资料以及随访9～12个月冠状动脉造影结果。结果:JBT组手术时长、射线及造影剂剂量均小于JWT组,JBT组术中胸痛、慢血流或无复流发生率低于JWT组;JBT组术后48 h心肌肌钙蛋白I水平低于JWT组;支架后即刻和术后9～12个月的冠状动脉造影显示,JBT组分支的最小管腔直径大于JWT组,最大狭窄程度小于JWT组,分支闭塞发生率低于JWT组,差异均有统计学意义(P<0.05)。结论:在分支直径1.5～2.5 mm,狭窄程度50%～75%、V-RESOLVE高危的真性分叉病变中,对比JWT与JBT在保护分支方面无论是手术即刻和近远期上都有更好的安全性和有效性。     

预扩张球囊技术与单纯导丝保护技术在冠状动脉真性分叉病变患者经皮冠状动脉介入治疗中应用效果的对比研究

目的比较预扩张球囊技术与单纯导丝保护技术在冠状动脉真性分叉病变患者经皮冠状动脉介入治疗(PCI)中的应用效果。方法选取2007—2016年在玉林市玉州区人民医院心血管内科行PCI的冠状动脉真性分叉病变患者166例,按照手术方式不同分为球囊组87例和导丝组79例。两组患者均在主支血管置入支架,并采用简单处理策略保护分支血管病变,球囊组患者PCI术中采用预扩张球囊技术,而导丝组患者PCI术中采用单纯导丝保护技术。比较两组患者术后并发症发生情况和手术情况;随访1年,记录两组患者主要不良心血管事件(MACE)发生情况、病变血管狭窄情况及再次住院率。结果两组患者分支血管球囊及导丝未发生截留或断裂,术后未出现严重血管并发症、死亡和急性心肌梗死。两组患者临床症状、心肌损伤发生率比较,差异无统计学意义(P0.05);球囊组患者分支血管闭塞或夹层发生率低于导丝组(P0.05)。两组患者PCI成功率、分支血管置入支架者所占比例、手术时间、X线暴露时间及造影剂用量比较,差异无统计学意义(P0.05);球囊组患者行对吻后扩张者所占比例和术中分支血管无复流发生率低于导丝组(P0.05)。球囊组患者随访期间MACE发生率、分支血管开口狭窄率低于导丝组(P0.05),而两组患者主支血管最大狭窄率、主支血管再狭窄率及再次住院率比较,差异无统计学意义(P0.05)。结论与单纯导丝保护技术相比,预扩张球囊技术对冠状动脉真性分叉病变患者PCI后分支血管病变的保护作用更好,能更有效地降低术后分支血管闭塞或夹层发生率、MACE发生率及分支血管开口狭窄率。     

棘突球囊与球囊拘禁在老年冠脉分叉病变介入治疗中的应用效果

目的 探讨棘突球囊与球囊拘禁技术在老年冠状动脉粥样硬化性心脏病(CAD)患者经皮冠状动脉介入(PCI)中处理冠脉分叉病变时的应用效果.方法 选取准备行PCI治疗的老年冠脉分叉病变患者90例,随机分为棘突球囊组(47例)和球囊拘禁组(43例),PCI处理冠脉分叉病变时棘突球囊组使用棘突球囊预扩主支及导丝拘禁保护边支技术,...     

单支架与双支架术式分支球囊保护策略对冠状动脉前降支分叉病变患者的疗效比较研究

背景冠状动脉前降支分叉病变发生率及术后不良心血管事件发生率高,而明确合适的球囊保护策略对改善患者预后具有重要意义。目的比较单支架与双支架术式的分支球囊保护策略对冠状动脉前降支分叉病变的疗效。方法选取2015年1月—2018年1月都江堰市医疗中心收治的冠状动脉前降支真性分叉病变患者260例,根据分支球囊保护策略分为观察组(n=108)和对照组(n=152)。在基础治疗上,对照组患者采用双支架术式分支球囊保护策略,观察组患者采用单支架术式分支球囊保护策略。记录两组患者手术时间,球囊使用数量,支架植入数量,导丝使用数量,对比剂用量,术中分支血管慢血流、血流限制性夹层/分支血管闭塞,术后心肌梗死、心肌酶谱增高、主支及分支血管TIMI血流3级发生率,观察随访期间两组患者不良心脑血管事件及靶血管再次血运重建方式。结果观察组患者手术时间短于对照组,球囊使用数量、支架植入数量、导丝使用数量、对比剂用量低于对照组(P0.05)。两组患者术中分支血管慢血流、血流限制性夹层/分支血管闭塞发生率及术后心肌梗死,心肌酶谱增高,主支、分支血管TIMI血流3级,再发心绞痛,主分支血管再狭窄,非致死性心肌梗死发生率比较,差异均无统计学意义(P0.05)。观察组患者再狭窄程度高于对照组(P0.05)。两组患者再次行经皮冠状动脉介入治疗、冠状动脉旁路移植术率比较,差异无统计学意义(P0.05)。结论单支架及双支架术式的分支球囊保护策略治疗冠状动脉前降支真性分叉病变患者效果较好,与双支架术式比较,单支架术式可缩短患者手术时间,减少球囊使用数量、支架植入数量、导丝使用数量及对比剂用量,但会增加患者再狭窄程度。     

改良拘禁球囊保护技术在冠状动脉非左主干分叉病变中预防分支闭塞有效性的随机对照研究

目的:评估改良拘禁球囊保护技术在冠状动脉非左主干分叉病变中预防分支闭塞的有效性。方法:连续入选2015年5月至2019年12月在中国医学科学院阜外医院行经皮冠状动脉介入治疗(PCI)且符合入选标准的患者,冠状动脉造影证实靶病变为非左主干分叉病变。将患者随机分为改良拘禁球囊保护技术组(PBT组)和拘禁导丝保护技术组(JWT组)。记录所有患者的临床资料,比较两组主支置入支架后分支闭塞的发生率、术毕分支TIMI 3级血流的比例、分支重进导丝的比例和成功率、围术期心肌梗死的发生率。结果:共入选432例患者,PBT组与JWT组各216例。PBT组在PCI术中分支闭塞的发生率明显低于JWT组(0.93%vs. 4.17%,P=0.03),真性分叉病变PCI术中分支闭塞的发生率也明显低于JWT组(0.58%vs. 5.39%,P0.01)。PBT组1例(0.46%)分支需要重进导丝,并置入支架;JWT组6例(2.78%)需要重进分支导丝,其中2例(33.33%)分支重进导丝失败,4例(66.67%)对分支进行扩张。两组需要重进导丝的比例和再进导丝的成功率、术毕主支和分支TIMI 3级血流的比例以及围术期心肌梗死的发生率、心原性死亡和靶病变再次血运重建发生率的差异均无统计学意义(P均 0.05)。结论:与JWT相比,PBT可有效降低分叉病变介入治疗分支闭塞的发生率,且有降低围术期心肌梗死发生率的趋势。     

边支深部预埋球囊技术在冠脉非左主干分叉病变介入治疗中的作用

目的探究在冠脉非左主干分叉病变介入治疗中应用边支深部预埋球囊技术的效果。方法 60例冠脉分叉病变患者(均行介入治疗),随机分为对照组30例(应用单导丝保护技术治疗)和实验组30例(应用边支深部预埋球囊技术治疗)。均随访一年,对比两组患者手术成功率、手术时间、对比剂用量、X射线曝光时间、病变冠脉狭窄情况、心血管不良事件发生率。结果实验组手术时间、对比剂用量、X射线曝光时间相比对照组明显更少(P<0.05);实验组手术成功率(93.33%)高于对照组(63.33%),P<0.05;且随访1年发现,实验组心血管不良事件发生率(3.33%)较对照组(23.33%)更低(P<0.05);实验组主支血管狭窄情况和对照组无显著差异(P>0.05),但实验组边支血管开口狭窄程度较对照组更小(P<0.05)。结论在冠脉非左主干分叉病变介入治疗中应用边支深部预埋球囊技术的效果更优,手术成功率更高,具有手术时间、对比剂用量及X射线曝光时间少等优点,且更有助于降低心血管不良事件发生率及减小边支血管开口狭窄程度。     

3D-OCT验证拘禁球囊技术对分支开口的保护作用

目的应用三维光学相干断层成像(OCT)验证拘禁球囊技术对分支开口的保护作用。方法本研究为回顾性研究。连续入选2019年9月至2022年3月在解放军总医院行经皮冠状动脉介入治疗并分别于手术前后完成OCT检查的冠状动脉分叉病变患者。根据所采用的分支保护策略将患者分为拘禁球囊组和未保护组。通过OCT图像计算患者的分支开口面积差(分支开口面积差=术后分支开口面积-术前分支开口面积)。比较两组的分支开口面积差, 并在真性分叉病变和非真性分叉病变亚组中再次比较。在拘禁球囊组中, 分别比较使用主动拘禁球囊技术和传统拘禁球囊技术者、使用直径>2.0 mm拘禁球囊和≤2.0 mm拘禁球囊者、给予较大球囊压力(>4 atm, 1 atm=101.325 kPa)和较小的球囊压力(≤4 atm)者的分支开口面积。采用多因素线性回归分析探索拘禁球囊技术参数与分支保护作用的相关性。结果共入选176例患者, 共含有236个分叉病变, 年龄(60.7±9.3)岁, 其中男性128例(72.7%)。拘禁球囊组67例患者包含71例分叉病变, 未保护组123患者包含165例分叉病变(14例患者存在2～3处分叉...     

动态支架显像功能在冠脉介入治疗中的应用

目的评价动态支架显像功能在介入治疗中不同病变的应用价值。方法自2011年9月至2012年8月(排除急性心肌梗死患者),连续完成100例应用动态支架显像功能指导的择期冠心病介入治疗患者,包括分叉病变、开口病变、左主干病变、再狭窄病变及慢性完全闭塞病变介入治疗中应用动态支架显像功能,同期完成介入治疗的同类病变(ACC/AHA分型)作为对照组,比较两组间介入治疗手术时间、造影剂用量和术后肌酐增加情况,评价动态支架显像在介入治疗中的作用。结果两组比较基线水平包括年龄、性别、高血压、糖尿病、吸烟、心肌梗死、体重指数无差别,病变类型、曝光时间、置入支架数量均无统计学差别(P>0.05),曝光时间(22.3±10.9与22.5±10.1min,P=0.259)相似,但研究组造影剂用量较对照组用量更少(101.9±34.1ml与114.4±41.7ml,p=0.021),差别有统计学意义,术后肌酐增加没有差异(11.41±3.14与2.15±3.37umol/l,P=0.109)。结论动态支架显像功能能准确指导支架支架串联及分叉病变完成最终对吻扩张、左主干开口病变支架置入后扩张球囊与支架关系定位、再狭窄病变再次介入治疗与既往置入支架串联以及扩张支架近端边缘球囊的准确定位,减少造影剂用量。     

拘禁球囊技术治疗冠状动脉分叉病变的临床疗效

目的探讨采用拘禁球囊技术(JBT)治疗冠状动脉分叉病变的临床疗效。方法总结56例行经皮冠状动脉介入治疗(PCI)术采用JBT治疗真性分叉病变病人,观察术后即刻病变血管成功率和住院期间及随访12个月不良事件发生率。结果 56例病人中即刻手术成功54例(96.34%),27例(48.21%)完成对吻球囊扩张术。2例病人出现边支近端夹层病变。56例完成随访,随访期1例发生主要心血管事件(MACE),发生率为1.9%;7例(13.0%)完成术后冠状动脉造影复查,未见原支架及边支再狭窄。结论 JBT治疗冠状动脉分叉病变介入是安全有效的,且预后较好。     

The effects of types of guidewires and pressure applied during stent implantation in the main vessel on the incidence of damage to coronary guidewires during angioplasty of coronary bifurcation lesions—Wide Beast study

Objectives

We evaluated the impact of stent inflation pressure and type of guidewire on “jailed” coronary guidewire damage occurring during bifurcation angioplasty.

Background

Despite new techniques and treatment options during percutaneous coronary intervention (PCI) we still observe peri‐ and postoperative complications for to various known and unknown reasons.

Methods

Patients undergoing PCI within the coronary bifurcation were randomly assigned to one of four groups: Pilot 50 or BMW guidewire and pressure ≤12 or >12 atm. After PCI each “jailed” guidewire was evaluated under an optical microscope. The Wide Beast Scale (WBS) was developed for the internal purposes of the study and was used for qualitative assessment. Also, the inflation pressure, the patients’ characteristics and the technical parameters of the procedure were recorded.

Results

The clinical characteristics were similar in all the groups. There was no statistical significance of the degree of damage, rated on the WBS, for either guidewire group with respect to inflation pressure (P = 0.49). The prevalence of guidewire damage was higher in the BMW versus the Pilot 50 group (98.4% vs 67.4% respectively, P = 0.00001) as was the severity of the damage (grades 3 and 4) in BMW versus Pilot 50 (55.6% vs 13.0% respectively, P = 0.00001).

Conclusions

The inflation pressure during stent implantation had no impact on “jailed” guidewire damage. The difference in the prevalence of serious damage and total damage number was statistically significant for the BMW guidewire compared to the Pilot50. The BMW guidewire was an independent predictor of the degree of damage to the guidewire.

     

A novel 0.010‐inch guidewire for crossing jailed sidebranches

Complete occlusion of a side branch sometimes occurs due to a jailed‐stent during treatment of bifurcation lesions. In this report, we describe a novel 0.010‐inch coronary guidewire (Decillion?) that is effective for crossing a completely occluded side branch through the jailed‐stent strut, whereas another standard 0.014‐inch guidewire was unable to cross the same lesion. This novel 0.010‐inch guidewire may be useful for crossing of completely occluded side branches that are difficult to cross through the stent strut after stent implantation. © 2009 Wiley‐Liss, Inc.     

Novel Insights of Jailed Balloon and Jailed Corsair Technique for Percutaneous Coronary Intervention of Bifurcation Lesions

BackgroundThe optimal technique for percutaneous coronary intervention (PCI) of a bifurcation lesion remains uncertain. JBT/JCT techniques are now emerging for protection of the side branch (SB). We aimed to compare jailed balloon (JBT) and jailed Corsair (JCT) techniques to the conventional jailed wire technique.MethodsWe analyzed 850 consecutive patients (995 bifurcation lesions), who underwent PCI. The bifurcation lesions were classified as jailed wire (?), jailed wire (+), JBT, and JCT. We assessed temporary thrombolysis in myocardial infarction (TIMI) flow grade ≤2, permanent TIMI flow grade ≤2 in the SB, and SB occlusion related myocardial infarction and compared these endpoints with inverse probability treatment weighted analysis.ResultsThe percentage of each group is as follows: jailed wire (?); 44.7%; jailed wire (+) 50.9%; JBT 1.7%; JCT 2.7%. The Corsair could not be delivered with a stent because of severe calcifications (3.7%) and a jailed balloon was entrapped with the stent after dilatation (5.9%). Compared to the jailed wire (+), JBT/JCT had a higher percentage of true bifurcations, arterial sheath size ≥7 Fr, and a lower proportion of wire recrossing (all, P < 0.05). After adjustment, temporary and permanent TIMI flow grade ≤2 in the SB, and SB occlusion related myocardial infarction were not significantly different (OR: 1.08, CI: 0.32–3.71, P = 0.90; OR: 0.88, CI: 0.11–6.91, P = 0.91; OR: 1.94, CI: 0.23–16.5, P = 0.55 respectively).ConclusionsOur data could not prove the efficacy of JBT/JCT, but revealed novel insights about these techniques. A larger study is necessary to prove the efficacy of JBT/JCT.     

Stent Deformation Caused by Entrapment of the Side Branch Balloon Catheter During the Jailed Balloon Protection Technique for a Calcified Coronary Bifurcation Lesion: A Case Report and Literature Review

Percutaneous coronary intervention (PCI) for true bifurcation lesions is challenging. Although the jailed balloon protection technique is an established method with which to prevent side branch occlusion during the treatment of bifurcation lesions, little is known regarding the potential risks of this technique. We describe a 71-year-old man with exertional angina pectoris who was treated with PCI for a calcified true bifurcation lesion in the left anterior descending artery and diagonal branch. After performing rotational atherectomy (1.75 mm burr) for the main vessel and pre-dilatation for both the main vessel and side branch, we performed the jailed balloon technique to protect the large diagonal branch during stent implantation. However, the jailed balloon was entrapped after main vessel stent balloon inflation. The entrapped jailed balloon was then inflated again and successfully removed after balloon deflation, but significant stent deformation was seen with intravascular ultrasound imaging. Fortunately, post-dilatation was successfully performed with a non-compliant balloon, and a final coronary angiogram showed acceptable results. This case report and literature review highlights a potential risk of the jailed balloon technique and conceivable alternatives during PCI for true bifurcation lesions.     

主支支架加边支预埋球囊治疗冠状动脉分叉病变的疗效及安全性观察

目的 探讨主支支架加边支预埋球囊治疗冠状动脉分叉病变的临床疗效及手术安全性.方法 以江苏省徐州市中心医院2012年10月至2013年7月收治的冠状动脉分叉病变患者86例为研究对象,采用主支支架加边支预埋球囊术进行治疗.依据研究组患者的基线资料特点,选取行单导丝边支保护的60例边支病变患者为对照组.术后,对比评价两组患者的介入治疗成功率、并发症发生率以及随访1年后的心肌梗死溶栓试验（thrombolysis in myocardial infarction,TIMI）血流分级、TIMI心肌灌注（TIMI myocardial perfusion,TMP）血流分级等.结果 术后,研究组和对照组的介入治疗成功率分别为98.84％和85.71％,并发症发生率分别为1.16％和11.11％,组间比较差异具有统计学意义（P＜0.05）.随访1年期间,研究组的主要心血管事件发生率低于对照组,差异具有统计学意义[6.98％（6/86） vs.31.75％（20/63） P＜0.05];TIMI血流分级、TMP血流分级以及右心室舒张末期内径和右心室射血分数均优于对照组,差异具有统计学意义（P＜0.05）.结论 主支支架加边支预埋球囊可提高冠状动脉分支病变患者的介入治疗成功率,降低并发症的发生率,血运重建效果良好,具有较好的远期疗效.     

Orbital Atherectomy for Treatment of Severely Calcified Coronary Artery Bifurcation Lesions: A Multicenter Analysis

ObjectiveThis study evaluated the safety and efficacy of orbital atherectomy (OA) for the treatment of severely calcified coronary artery bifurcation lesions.BackgroundPercutaneous coronary intervention (PCI) of severely calcified coronary artery lesions is associated with lower procedural success and higher rates of target lesion failure compared to non-calcified lesions. OA is an effective treatment for calcified coronary artery lesions prior to stent implantation. However, there is little data regarding the safety and efficacy of OA in patients with coronary artery bifurcation lesions.MethodsData were obtained from analysis of patients with severe coronary artery calcification who underwent OA and coronary stent implantation at ten high-volume institutions. Data were pooled and analyzed to assess peri-procedural outcomes and 30-day major adverse cardiac events (MACE).ResultsA total of 1156 patients were treated with OA and PCI. 363 lesions were at a coronary artery bifurcation. There were no statistically significant differences in baseline characteristics between the bifurcation and non-bifurcation groups. In the bifurcation group, treatment involved the left anterior descending artery and its branches more frequently and right coronary artery less frequently. After propensity score matching, the 30-day freedom from MACE was not statistically significant between the two groups.ConclusionIn this multicenter cohort analysis, patients with severely calcified coronary bifurcation lesions had low rates of MACE and target vessel revascularization at 30 days at rates comparable to non-bifurcation lesions. This analysis demonstrates that OA is safe and effective for complex coronary lesions at both bifurcation and non-bifurcation locations.     

A Systematic Review of Jailed Balloon Technique for Coronary Bifurcation Lesion: Conventional-Jailed Balloon Technique vs Modified-Jailed Balloon Technique

BackgroundIn this systematic review, we aim to evaluate the latest evidence on the efficacy and safety of conventional jailed balloon technique and modified jailed balloon technique for bifurcation lesion, and also whether the former or latter is more effective for preventing side branch occlusion during main branch stenting in bifurcation lesions.MethodsWe performed comprehensive search on studies assessing the efficacy and safety of conventional jailed balloon and modified jailed balloon technique for bifurcation lesion from several electronic databases.ResultsThere were 908 patients from six studies comprising of 615 in conventional jailed balloon technique group and 293 in modified jailed balloon technique group. Side branch loss was lower in modified jailed balloon technique group, however, the proportion of lesions with TIMI flow <3 in the final percutaneous coronary intervention result was somewhat higher in the modified jailed balloon technique group. The efficacy issue regarding side branch dissection was reported as high as 3.4%, especially at proximal stent edge in conventional jailed balloon technique group, but not quantitatively described in the modified jailed balloon technique group. Zero percent major adverse cardiovascular events at 9–12 months follow up was demonstrated in modified jailed balloon technique group, and 1–5% in the conventional jailed balloon group at a longer observation period up to 2.7 years.ConclusionOur study showed that modified jailed balloon technique is potentially better compared to conventional jailed balloon in terms of side branch loss, dissection, and major adverse cardiovascular events. Further controlled studies are warranted for definite conclusion.     

Stenting of bifurcation lesions: a rational approach

The occurrence of stenosis in or next to coronary bifurcations is relatively frequent and generally underestimated. In our experience, such lesions account for 15%-18% of all percutaneous coronary intervention > (PCI). The main reasons for this are (1) the coronary arteries are like the branches of a tree with many ramifications and (2) because of axial plaque redistribution, especially after stent implantation, PCI of lesions located next to a coronary bifurcation almost inevitably cause plaque shifting in the side branches. PCI treatment of coronary bifurcation lesions remains challenging. Balloon dilatation treatment used to be associated with less than satisfactory immediate results, a high complication rate, and an unacceptable restenosis rate. The kissing balloon technique resulted in improved, though suboptimal, outcomes. Several approaches were then suggested, like rotative or directional atherectomy, but these techniques did not translate into significantly enhanced results. With the advent of second generation stents, in 1996, the authors decided to set up an observational study on coronary bifurcation stenting combined with a bench test of the various stents available. Over the last 5 years, techniques, strategies, and stent design have improved. As a result, the authors have been able to define a rational approach to coronary bifurcation stenting. This bench study analyzed the behavior of stents and allowed stents to be discarded that are not compatible with the treatment of coronary bifurcations. Most importantly, this study revealed that stent deformation due to the opening of a strut is a constant phenomenon that must be corrected by kissing balloon inflation. Moreover, it was observed that the opening of a stent strut into a side branch could permit the stenting, at least partly, of the side branch ostium. This resulted in the provocative concept of "stenting both branches with a single stent." Therefore, a simple approach is currently implemented in the majority of cases: stenting of the main branch with provisional stenting of the side branch. The technique consists of inserting a guidewire in each coronary branch. A stent is then positioned in the main branch with a wire being "jailed" in the side branch. The wires are then exchanged, starting with the main branch wire that is passed through the stent struts into the side branch. After opening the stent struts in the side branch, kissing balloon inflation is performed. A second stent is deployed in the side branch in the presence of suboptimal results only. Over the last 2 years, this technique has been associated with a 98% angiographic success rate in both branches. Two stents are used in 30%-35% of cases and final kissing balloon inflation is performed in > 95% of cases. The in-hospital major adverse cardiac events (MACE) rate is around 5% and 7-month target vessel revascularization (TVR) is 13%. Several stents specifically designed for coronary bifurcation lesions are currently being investigated. The objective is to simplify the approach for all users. In the near future, the use of drug-eluting stents should reduce the risk of restenosis.     

无保护左主干分叉病变研究进展

随着经皮冠状动脉介入技术的迅速发展,应用药物洗脱支架治疗无保护左主干病变的安全性和有效性已得到临床证实.而无保护左主干分叉病变具有与非左主干分叉病变不同的特征.理解无保护左主干分叉病变的分型、局部解剖特点,熟练掌握无保护左主干分叉病变手术方式具有重要意义.     

冠状动脉分叉病变单支架治疗分支是否需要对吻后扩张

冠状动脉分叉病变是冠状动脉介入治疗的一个难点。尽管药物洗脱支架的广泛使用提高了介入治疗分叉病变的疗效,但选择双支架还是单支架、单支架分支开口狭窄是否对吻后扩张、单支架分支血管术中及术后闭塞风险和支架内血栓问题仍值得研究。现就单支架治疗冠状动脉分叉病变分支血管是否对吻后扩张做一综述。