冠状动脉分叉病变单支架术及双支架术临床疗效对比

目的探讨分叉病变单支架术和双支架术的临床疗效。方法分析冠状动脉分叉病变102例的临床资料,其中52例行单支架术（单支架植入组）、50例行双支架术（双支架植入组）。单支架植入组仅主支植人支架,边支不植入支架;双支架植入组运用mini-crushing技术行双支架植入术。观察两组分叉病变的手术即刻及术后6个月临床疗效及主要心血管事件的发生情况。结果术后即刻冠状动脉造影结果显示两组主支血管心肌梗死溶栓试验（thrombolysisinmyocardialinfarction．TIMI）血流3级、分支血管TIMI血流3级、主支血管残余狭窄〉30％、分支血管残余狭窄〉50％四个指标比较,均差异无统计学意义（P〉0．05）。随访6个月后对两组进行冠状动脉造影后发现,分支血管残余狭窄〉50％在单支架植入组发生率高于双支架植入组,差异有统计学意义[25．0％（13／52）vs．12．0％（6／50）,P〈0．05];其余几项两组比较,差异无统计学意义（P〉0．05）。住院期间单支架植入组1例（1．92％）发生主要心血管事件,双支架植入组2例（4．00％）发生主要心血管事件。6个月后．单支架植入组8例（15．38％）发生主要心血管事件,双支架植入组7例（14．00％）发生主要心血管事件。结论单支架术与双支架术治疗分叉病变短期观察临床疗效基本无差异,其长期疗效还需进一步研究。     

血管内超声指导对于冠状动脉真性分叉病变介入治疗长期预后的影响

目的研究血管内超声（intravascular ultrasound,IVUS）指导对于冠状动脉真性分叉病变植入药物洗脱支架（drug eluting stent,DES）长期预后的影响。方法通过分析2005年10月至2010年3月DK—Crush系列随机对照研究入选735例原位冠状动脉真性分叉病变植入DES患者,应用倾向评分匹配临床和造影特征,165例IVUS指导和165例冠状动脉造影指导患者纳入研究,比较两组患者的长期预后。结果两组临床基线资料和造影特征比较,差异无统计学意义（P〉0．05）。IVUS指导组更常见选择双支架策略（P=0．007）,IVUS指导组主支血管（MV）和分支血管（SB）的最大支架直径和支架总长度以及分支血管支架个数显著超过常规造影指导组;介入治疗后QCA分析显示,IVUS指导组分支血管参考血管直径（RVD）和即刻获得以及主支血管近端和分支血管最小管腔直径（MLD）显著超过造影指导组。12个月随访发现两组心脏死亡、靶病变重建（TLR）和主要心血管事件（MACE）比较,差异无统计学意义（P〉0．05）。然而,IVUS指导组晚期支架内血栓和急性心肌梗死发生率显著低于造影指导组,差异有统计学意义（0．6％ vs.4．8％。P=0．04;1．8％ vs.6．7％,P=0．03）。结论IVUS指导冠状动脉真性分叉病变植入DES可以显著减低晚期支架内血栓和由此引起急性sT段抬高心肌梗死发生率而改善长期预后。     

Crush及Culotte术式治疗冠状动脉分叉病变的主要不良心脏事件风险比较

目的研究Culotte techniques(DK-Mini-Culotte)双支架术及Crush techniques(DKMini-Crush)双支架术式治疗冠状动脉分叉病变主要不良心脏事件发生情况。方法纳入2015年7月至2019年1月中国科学技术大学附属第一医院收治的221例冠状动脉分叉病变患者,按照手术方式分两组,其中观察组行DK-Mini-Crush术(154例),对照组接受DK-Mini-Culotte术(67例)。比较两组造影特征及经皮冠状动脉介入治疗(PCI)情况(包括主支病变长度、分支病变长度、主支支架长度、分支支架长度、平均支架植入数、手术时间、造影剂总量、住院天数及病变分布特点、手术成功率、最终对吻球囊扩张成功率、主支即刻造影成功率、分支即刻造影成功率),分析两组术后主要不良临床事件发生情况。结果两组主支病变长度、分支病变长度、主支支架长度、分支支架长度、平均支架植入数、手术时间、造影剂总量、住院天数及病变分布情况、手术成功率、最终对吻球囊扩张成功率、主支即刻造影成功率、分支即刻造影成功率比较差异均无统计学意义(P> 0.05)。观察组术后支架内再狭窄率为1.30%,显著低于对照组的7.46%(χ2=3.948,P <0.05),出血、再发心绞痛、心源性死亡、病变血运重建所占比例较对照组比较差异均无统计学意义(P> 0.05)。结论 DK-Mini-Crush术与DK-Mini-Culotte术治疗冠状动脉分叉病变最终对吻球囊扩张成功率均较高,均具有良好的临床及造影结果,但后者支架内再狭窄率相对较高,临床应引起足够重视。     

Jailed 球囊保护在冠状动脉分叉病变处理中的初步应用

目的：探讨Jailed球囊技术在冠状动脉分叉病变主支血管支架加分支血管备选T-支架处理中的作用。方法对57例接受主支血管支架加分支血管备选T-支架治疗的患者临床资料和冠状动脉介入治疗过程记录的DICOM格式的造影录像进行分析,测定治疗前后主支血管病变处与分支血管开口的最小直径、主支与分支血管夹角,计算术前和术后变化差值,并作Jailed球囊与Jailed导丝组之间的比较。结果共有57例60个分叉病变接受Jailed导丝（39例）或Jailed球囊（18例）分支保护下的主支血管支架植入手术。Jailed导丝组发生分支血管闭塞3例,TIMI血流≤2级的5例,Jailed球囊组分支血管闭塞1例。分支血管开口最小直径术后与术前变化差值Jailed导丝组为（-0.34±0.39）mm,Jailed球囊组为（0.08±0.64）mm,差异有显著统计学意义（t=3.144,P＜0.01）。分叉血管夹角术后Jailed导丝组缩小,Jailed球囊组增大,变化值差异有显著统计学意义[（-3.82±9.04）°、（3.54±7.76）°;t=3.102,P＜0.01]。结论在冠状动脉分叉病变主支血管支架加分支血管备选T-支架治疗中,Jailed球囊技术有利于防范分支血管开口严重挤压甚或闭塞的发生。     

冠心病分叉病变不同处理方法疗效研究

目的 探讨应用药物支架治疗冠心病分叉病变时对开口狭窄的分支血管不同处理方法的疗效.方法 入选66例主支血管药物支架置入术后引起直径≥2.0mm且＜2.5mm分支血管开口狭窄大于50%的、于术后6～12个月间接受冠状动脉造影随访的患者,根据分支血管采取的不同治疗方法分成2组,即主支置入支架、分支血管单纯球囊扩张组(球囊扩张组)和主支置入支架、分支未处理组(未处理组).观察分支血管开口狭窄程度变化及主要不良心血管事件发生情况.结果 于术后6～12个月接受冠状动脉造影复查随访时,虽然分支开口狭窄程度在球囊扩张组优于未处理组,但两组间主支血管再狭窄率和主要不良心血管事件发生率差异无统计学意义(P＞0.05).结论 对支架置入后开口狭窄的分支血管采取单纯球囊扩张治疗并没有改善远期临床预后.     

双导丝球囊在处理分叉病变中的应用

目的 评价冠状动脉分叉病变主支植入支架联合分支,双导丝球囊(Dual-Wire Balloon)单纯扩张治疗分叉病变的有效性和安全性.方法 Lefevre Ⅰ型冠状动脉分叉病变36例共41处,采用双导丝球囊行边支和(或)主支扩张,主支植入支架,观察住院及随访期间的疗效及主要心脏不良事件的发生率.结果 41处分叉病变主支支架植入前行边支双导丝球囊预扩张均成功,4例主支行直接支架术,37处分叉病变主支双导丝球囊预扩张成功后植入主支支架,主支支架后5例边支明显受压,心肌梗死试验性溶栓疗法(thrombolysis in myoxardial infarction trial,TIMI)血流不足3级的分叉病变行对吻扩张均成功.住院期间无Q波心肌梗死、急诊血运重建及死亡;平均随访16个月,期间无Q波心肌梗死、再次血运重建、死亡等严重临床并发症,心绞痛复发3例,强化药物治疗后均缓解.结论 用双导丝球囊处理分叉病变可以获得较好的效果,主支支架联合分支双导丝球囊单纯扩张治疗分叉病变是一种简单和有效的处理方法.     

应用切割球囊结合支架术治疗冠状动脉分叉处病变89例

目的 :评价经皮冠状动脉腔内切割球囊成形术 （PTCBA）结合支架术治疗冠脉分叉处病变的安全性及疗效。方法 :对 89例冠心病患者主支病变应用 PTCBA预扩张后置入支架、分支病变单行 PTCBA而不置入支架 ,观察其冠脉病变特点、手术过程相关因素、手术成功率、并发症和近、中期随访结果。结果 :89例患者中分叉处病变位于前降支 /对角支占 71% ,回旋支 /钝圆支占 2 5 % ,右冠脉 /后降支或后侧支占 4%。对分支血管行 PTCBA后 1例因残余狭窄 >5 0 %而植入支架 ,1例因并发轻度钙化且分支成角较大切割球囊未通过 ,改用常规 PTCA球囊扩张成功。病变 PTCBA成功率达 97.8% ;无院内死亡、急性心肌梗死 （AMI）、急性心包填塞及急诊冠脉搭桥术等严重并发症。对手术成功的 87例术后临床随访 3～ 2 6个月 ,无死亡及 AMI等心脏事件发生。临床心绞痛复发率 17.2 %。复查冠脉造影 （CAG）率 5 6.3 % ,示 49处分叉病变主支支架内再狭窄率 14.3 % ,分支血管再狭窄率 18.4%。结论 :PTCBA结合支架术治疗冠脉分叉处病变是一种安全、有效的介入治疗技术 ,其成功率高、并发症少 ,近、中期疗效满意     

TAP技术与改良mini-Crush技术治疗冠状动脉分叉病变临床效果的对比研究

目的比较TAP技术与改良mini-Crush(MMC)技术治疗冠状动脉分叉病变的临床效果。方法选取2013年4月—2015年4月绵阳市中心医院收治的冠状动脉分叉病变患者138例,采用随机数字表法分为TAP组(A组)70例和MMC组(B组)68例。A组患者采用TAP技术,B组患者采用MMC技术。比较两组患者经皮冠状动脉介入治疗(PCI)成功率,靶病变部位(左主干-前三叉、前降支-对角支、回旋支-钝缘支、右冠状动脉-后三叉)、病变特点(主支病变长度、边支病变长度、主支狭窄程度、边支狭窄程度、分叉角度)、置入支架情况(总支架数量、主支支架长度、边支支架长度)、手术时间、X线暴露时间、对比剂用量、PCI相关心肌梗死发生情况、随访12个月主要不良心血管事件(心源性死亡、非致死性心肌梗死、靶血管血运重建)、支架内血栓形成、靶病变(主支、分支)再狭窄发生情况。结果两组患者PCI成功率比较,差异无统计学意义(P0.05)。两组患者靶病变部位、主支病变长度、边支病变长度、主支狭窄程度、边支狭窄程度、分叉角度,总支架数量、主支支架长度、边支支架长度,PCI相关心肌梗死发生率比较,差异均无统计学意义(P0.05);A组患者手术时间、X线暴露时间短于B组,对比剂用量少于B组(P0.05)。两组患者心源性死亡、非致死性心肌梗死、靶血管血运重建、支架内血栓形成、边支病变再狭窄发生率比较,差异无统计学意义(P0.05);A组患者主支病变再狭窄发生率低于B组(P0.05)。结论TAP技术治疗冠状动脉分叉病变的临床效果优于MMC技术,有利于缩短手术时间和X线暴露时间,减少对比剂用量、降低主支病变再狭窄发生率。     

国产雷帕霉素洗脱支架应用于冠状动脉分叉病变的效果评价

目的 评价冠状动脉分叉病变与非分叉病变支架植入术后预后是否存在差别.方法 回顾性分析1877例冠心病患者,其中568例冠状动脉分叉病变患者,1309例冠状动脉非分又病变患者.植入Excel支架.术后6、12及18个月临床随访两组主要不良心脏事件发生率的情况.结果 术后6、12及18个月两组死亡(心性和非心性)、非致死性心肌梗死及主要不良心脏事件的发生率均无差剐(P＞0.05),6及12个月两组靶病变血运重建的发生率无差别(P＞0.05),18个月两组靶病变血运重建的发生率存在差别(P＜0.05).结论 Excel支架治疗冠状动脉分叉病变具有安全性和可靠性.     

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。     

Impact of Coronary Bifurcation Angle on Clinical Outcomes after Percutaneous Coronary Intervention in Real-World Practice: Results from the COBIS Registry

Objectives: Bifurcation angle has emerged as a predictor of outcome after percutaneous coronary intervention (PCI) for bifurcation lesions. We investigated the impact of bifurcation angle on clinical outcomes in patients undergoing bifurcation lesion PCI. Methods: Consecutive patients who received PCI for bifurcation lesions were enrolled from 16 centers in Korea between January 2004 and June 2006. Patients were divided into low-angle and high-angle groups using the median bifurcation angle (50°). We compared major adverse cardiac events, including cardiac death, myocardial infarction and target lesion revascularization as well as periprocedural outcomes between the 2 groups. Results: We evaluated 1,432 patients with bifurcation lesions with a median follow-up duration of 21 months. The rates of interventional side branch procedures such as guide-wiring of side branches, side-branch ballooning, final kissing ballooning and side-branch stenting were higher in the low-angle group. However, the incidences of major adverse cardiac events and target lesion revascularization were not significantly different between the 2 groups (6.6 vs. 6.9%, p = 0.856 and 4.6 vs. 5.7%, p = 0.375, respectively). Conclusions: Bifurcation angle may not influence long-term clinical outcome in patients with non-left main bifurcation lesion undergoing PCI despite its association with more interventional side-branch procedures.     

The Application of Dual-wire Balloon in The Treatment of Coronary Bifurcation Lesions

Objectives To assess the efficiency and safety of dual-wire balloon angioplasty side branch combined stenting the main branch in the treatment of coronary bifurcation lesions. Methods This study included thirty-six patients with 41 coronary bifurcation lesions. Selective dual-wire balloon angioplasty was performed in side branch and/or in main branch, and implantation of stents was performed in main branch only. Clinical outcome and major adverse cardiac events were observed in-hospital and follow-up. Results Success rate of side branch dilatation before main branch stenting was 100%; main branch direct stenting performed in 4 cases; success main branch dilatation performed in the other 37 cases; kissing technique was performed successfully in 5 cases, which side branch was jailed after main branch stenting with TIMI grade 0-2 flow. No Q-wave myocardial infarction, acute revascularization and death occurred during in-hospital. Clinical follow-up was available in all patients. No Q-wave myocardial infarction, revascularization and death occurred, angina pectoris recurred in three patients, released by strengthen drug treatment. Conclusions Dual-wire balloon angioplasty side branch combined stenting the main branch is simple, safe and effective for the treatment of coronary bifurcation lesions.     

Long-term outcomes after percutaneous coronary intervention of bifurcation narrowings

The optimal approach to percutaneous coronary intervention (PCI) of bifurcation lesions remains unclear, reflecting lack of long-term follow-up and heterogeneity of lesions encountered. We evaluated the long-term outcome of patients undergoing bifurcation PCI followed in the prospective bifurcation registry at the University Health Network, Toronto, Ontario, Canada. Of 526 patients undergoing bifurcation PCI between November 2003 and March 2005, most (n = 406) were treated by main vessel stenting only (n = 266) or crush/culotte stenting (n = 140). After median follow-up of 26.5 months, major adverse cardiac events (MACEs) and Canadian Cardiovascular Society class > or =2 angina occurred in 28.5% and 22.3% of patients in these groups, respectively (p = 0.190), whereas MACE rates were 20.8% for main vessel stenting and 18.7% for crush/culotte stenting (p = 0.670). A low bifurcation angle was associated with better outcomes in the crush/culotte group but had no effect on outcome of patients treated with main vessel stenting only. Use of crush/culotte techniques independently predicted freedom from MACEs or Canadian Cardiovascular Society class > or =2 angina compared with main vessel stenting only (odds ratio 0.55, 95% confidence interval 0.32 to 0.94, p = 0.029). In conclusion, the use of crush/culotte stenting is safe, with efficacy and MACE rates being similar to main vessel stenting alone. Our observations regarding the effect of lesion characteristics such as bifurcation angle and extent of side branch disease on outcome underscore the need for randomized trials that are inclusive of patients with complex side branch disease.     

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.     

Drug eluting stenting in bifurcation coronary lesions long-term results applying a systematic treatment strategy

Objectives : To explore the long‐term results following implantation of drug‐eluting stents (DES) in bifurcation lesions according to contemporary “real world” practice. Background : Limited information is available on the long‐term outcomes of patients with bifurcation lesions who are treated using DES. A systematic approach for bifurcation lesion management was applied, using either a “provisional” single stent technique or a dedicated two stents strategy according to the side‐branch diameter and severity of its ostial stenosis. Methods : Four hundred one consecutive patients underwent bifurcation percutaneous coronary intervention (PCI) using DES and were included in our prospective registry. All adverse events were recorded up to 2 years and distinguished according to the planned PCI strategy (e.g., one versus two stents technique). Results : A planned two stents strategy was used in 141 patients (35% of patients). In 260 patients (65%), the planned treatment involved stenting of the main branch only with “provisional” stenting of the side‐branch according to procedural course. Thus, 24 patients (9.2%) needed additional stenting at the side‐branch to complete the PCI. Cumulative major adverse cardiac event rate at 1 and 2 years was similar for both groups (11.4% vs. 14.8% at 1 year and 19.4% vs. 25.7% at 2 years for the single vs. two stents groups, accordingly, P = NS for both). Likewise, there was no difference in mortality, cardiac mortality, myocardial infarction, need for target lesions or target vessel revascularization, or definite stent thrombosis rate between the two groups at 6, 12, and 2 years follow‐up. The rate of angiographically confirmed (i.e., definite) stent thrombosis did not differ between the two groups during follow‐up. Conclusions : Our study revealed favorable long‐term clinical results following DES implantation using a systematic, rather simplified approach towards bifurcation stenting and using either a single or double stenting technique. © 2011 Wiley Periodicals, Inc.     

冠状动脉分叉病变单支架置入术的临床疗效评价

目的:总结101例冠状动脉分叉病变单支架置入术的临床疗效.方法:回顾性分析101例冠状动脉分叉病变患者,采用仅主支置入支架,边支不置入支架的手术策略,观察手术即刻及术后6～9个月临床疗效及主要心血管事件(MACE)发生率.结果:手术后即刻成功率99.01%(100/101),住院期间无MACE发生,术后6～9个月随访无症状者95.65%(88/92),发生稳定型心绞痛者2.17%(2/92),不稳定型心绞痛者2.17%(2/92),MACE发生率1.09%(1/92).结论:分叉病变采用仅主支置入支架,边支不置入支架的手术策略,短期观察安全有效.     

Immediate and long-term outcome of intracoronary stent implantation for true bifurcation lesions

OBJECTIVES: The aim of this study was to evaluate the immediate and long-term outcome of intracoronary stent implantation for the treatment of coronary artery bifurcation lesions. BACKGROUND: Balloon angioplasty of true coronary bifurcation lesions is associated with a lower success and higher complication rate than most other lesion types. METHODS: We treated 131 patients with bifurcation lesions with > or =1 stent. Patients were divided into two groups; Group (Gp) 1 included 77 patients treated with a stent in one branch and percutaneous transluminal coronary angioplasty (PTCA) (with or without atherectomy) in the side branch, and Gp 2 included 54 patients who underwent stent deployment in both branches. The Gp 2 patients were subsequently divided into two subgroups depending on the technique of stent deployment. The Gp 2a included 19 patients who underwent Y-stenting, and Gp 2b included 33 patients who underwent T-stenting. RESULTS: There were no significant differences between the groups in terms of age, gender, frequency of prior myocardial infarction (MI) or coronary artery bypass grafting (CABG), or vessels treated. Procedural success rates were excellent (89.5 to 97.4%). After one-year follow-up, no significant differences were seen in the frequency of major adverse events (death, MI, or repeat revascularization) between Gp 1 and Gp 2. Adverse cardiac events were higher with Y-stenting compared with T-stenting (86.3% vs. 30.4%, p = 0.004). CONCLUSIONS: Stenting of bifurcation lesions can be achieved with a high success rate. However, stenting of both branches offers no advantage over stenting one branch and performing balloon angioplasty of the other branch.     

Acute and long-term results of bifurcation stenting (from the Coroflex Registry)

Angioplasty of bifurcation lesions represents a continuing challenge. A total of 421 consecutive patients were prospectively followed in a registry on bifurcation stenting with a high-end bare metal stent (Coroflex, BBraun, Berlin, Germany), allowing side branch percutaneous transluminal coronary angioplasty through the stent struts without distraction of the main vessel stent from the vessel wall or other distortions. This approach obviated the 2-wire technique and kissing balloons. Detailed data, including lesion location, stenosis morphology, procedural success, and hospital and follow-up major adverse cardiac events (MACEs; acute myocardial infarction, death, revascularization, hospitalization due to angina), were collected from 6 European centers. Of the patients, 60% had stable angina, 23% had unstable angina pectoris/non-ST-elevation myocardial infarction, and 17% had ST-elevation myocardial infarction. In 17% of patients, the main vessel alone was stented; in 71%, stenting of the main vessel was complemented by side branch percutaneous transluminal coronary angioplasty. Technical success (residual stenosis <50%) in the 2 branches was achieved in 90% (main vessel in 99%). The rate of MACEs at discharge was 2%. After 6 months, 17% of patients had undergone target lesion revascularization or coronary artery bypass grafting. The total 6-month MACE rate was 22%. In conclusion, successful bifurcation stenting with a low MACE rate is possible in most patients using a simplified approach with a dedicated high-end bare metal stent.     

Sequential vs. kissing balloon angioplasty for stenting of bifurcation coronary lesions.

Coronary angioplasty of bifurcation lesions remains a technical challenge and is believed to result in low procedural success associated with the risk of side-branch occlusion. Furthermore, long-term results are associated with a high rate of reintervention. The aim of the study was to evaluate the immediate and long-term clinical and angiographic results of sequential vs. simultaneous balloon angioplasty (kissing balloon technique) for stenting of bifurcation coronary lesions. Between December 1999 and January 2001, 59 patients underwent coronary angioplasty because of symptomatic bifurcation lesions type III (i.e., side branch originates from within the target lesion of the main vessel, and both main and side branch are angiographically narrowed more than 50%). Twenty-six patients were treated with simultaneous and 33 patients with sequential balloon angioplasty. Main-vessel stent placement was mandatory; side-branch stenting and platelet IIb/IIIa antagonists were allowed at the discretion of the operator. Kissing balloon technique offered no advantage in terms of procedural success or need for repeat target vessel revascularization due to restenosis at 6-month follow-up. Using sequential balloon angioplasty, permanent or transient side-branch compromise rate (TIMI flow < 3) was significantly higher than after kissing balloon technique (33% vs. 0%, respectively; P = 0.003). Major clinical events in-hospital or at 6-month follow-up, however, showed no significant differences. Kissing balloon angioplasty reduces the rate of transient side-branch occlusion compared to sequential PTCA but does not improve immediate or long-term outcome compared to sequential PTCA for stenting of bifurcation lesions.     

TAP技术与必要性支架术处理冠状动脉分叉病变的疗效对比

目的 对比分析TAP技术与必要性支架术在处理边支大于2.0 mm冠状动脉分叉病变的临床效果.方法 将患者随机分为必要性支架组和TAP组.入选病例的冠状动脉造影均证实为MEDINA(1,1,1)型分叉病变,主支血管参考直径≥2.5 mm,边支血管参考直径≥2.0 mm.主要研究终点:术后12个月主要不良心血管事件的发生率和支架血栓发生率.次要终点包括:术后8个月冠状动脉造影随访再狭窄率、手术操作时间、曝光时间、对比剂用量、手术操作成功率、手术相关心肌梗死.结果 TAP组均完成最终对吻球囊扩张.12个月随访结果显示,TAP组主要不良心血管事件和必要性支架组差异无统计学意义(13.0%比12.1%,P＞0.05).两组均发生1例支架血栓事件.TAP组与必要性支架组术后24 h操作相关心肌梗死发生率差异无统计学意义(8.7%比5.2%,P＞0.05).两组在手术时间、X线曝光时间、对比剂用量差异无统计学意义.8个月冠状动脉造影结果显示,必要性支架组边支开口再狭窄明显高于TAP组(17.1%比3.8%,P＜0.05),总体再狭窄率两组差异无统计学意义.结论 TAP技术在处理大分支冠状动脉分叉病变的有效性及长期安全性方面不亚于必要性支架术.