不同介入方法治疗冠脉前降支分叉病变的临床疗效评价

目的：评价不同介入方法治疗冠状动脉前降支分叉病变的近、中期疗效。方法：39例经冠脉造影证实左冠前降支分叉病变的患者，接受了主支植入支架，分支分别采用无钢丝保护、钢丝保护、对吻球囊扩张术、Crush技术或改良Crush技术，术后对患者进行临床随访，回顾性分析其结果。结果：39例患者共植入支架56枚，药物支架21枚，其中前降支药物支架15枚。分支与主支对吻球囊扩张11例，其中2例对吻球囊扩张失败；Crush技术或改良Crush技术5例，其中1例未完成对吻扩张。术毕主支血管无残余狭窄或残余狭窄〈10％，3例分支血管残余狭窄〉50％，手术成功率为92．3％（36／39），无严重急性并发症出现。住院期间无主要心脏不良事件（MACE）发生，随访期间MACE发生率为2．6％（1／39）。结论：根据冠脉分叉病变的病理分型采用不同的介入治疗方法是安全、可行的，并且近中期临床疗效较好。

Evaluation of clinical outcomes of different percutaneous intervention techniques for treatment of coronary bifurcation lesions in left anterior descending artery

AIM:To evaluate the short-and mid-term outcomes of different percutaneous coronary intervention(PCI) techniques for treatment of coronary bifurcation lesions in the left anterior descending artery(LAD). METHODS:39 patients with bifurcation lesions in LAD proved by coronary angiography underwent stenting of the main branch, with no wire protection, wire protection, final kissing balloon inflation, crush stenting technique or modified crush technique of the side branch. Clinical follow-up were performed after the procedures and the results were analyzed retrospectively. RESULTS:56 stents(21 drug-eluting stents)were implanted in 39 patients and 15 drug-eluting stents in LAD. Of these, 11 cases were treated with stenting of the main branch and kissing balloon inflation of the side branch but 2 of them failed; 5 cases were treated with crush or modified crush technique but 1 of them failed. There were no remained stenosis or remained stenosis less than 10% in the main branch. There were 3 cases remained stenosis more than 50% in the side branch. A successful PCI procedure was achieved in 92.3%. There were no acute thrombosis, AMI, emergency CABG or death in PCI procedure. There were no major adverse cardiac events (MACE) during in hospital. The rate of MACE was 2.6% during the clinical follow-up. CONCLUSION: Different PCI techniques based on pathological classification for treatment of coronary bifurcation lesions are safe and feasible. And the short-and mid-term outcomes are satisfactory.