应用切割球囊与普通球囊治疗分叉病变的安全有效性分析

目的:对比简单策略治疗分叉病变过程中,应用切割球囊或普通球囊预扩张及血管成形术的有效性及安全性,为分叉病变治疗策略提供依据。方法:入选2009年至2013年期间,我院心内科218例冠心病患者233个分叉病变,分叉病变分型均为Duke D或Duke F型,边支血管直径>2.0mm,有明显血流动力学意义,主支病变经切割球囊预处理(CB组)或普通球囊预扩张(PB组)后置入支架,分支病变仅行切割球囊(CB组)或普通球囊预扩张(PB组),观察手术成功率、边支受累情况、并发症及随访主要心血管不良事件(MACEs)情况。结果:218例患者233个分叉病变位于前降支/第一对角支占73.4%(171例),回旋支/钝缘支占12.0%(28例),右冠状动脉/后降支或左心室后支占14.6%(50例)。CB组患者122例,PB组患者96例,两组患者临床基线资料与分叉病变特点比较,差异无统计学意义。CB组与PB组主支血管PCI成功率相似(98.1%vs.100%,P>0.05),但CB组患者分支血管PTCA成功率较高(92.1%vs.78.3%,P<0.05)。CB组患者围手术期心肌梗死发生情况亦少于PB组患者(4.1%vs.12.5%,P<0.05)。术后随访12个月结果表明,MACEs发生比率CB组少于PB组患者(5.31%vs.14.0%,P<0.05)。结论:简单策略治疗分叉病变过程中,应用切割球囊行预扩张及血管成形术对比普通球囊安全、有效,其成功率高,并发症较少,是临床实践中治疗冠状动脉分叉病变安全、有效、可行的方法。

The safety and efficacy of treating bifurcation lesions with cutting balloon versus conventional balloon in simple strategy

Objective: To evaluate the safety and efficacy of treating bifurcation lesions with cutting balloon angioplasty( CBA) versus conventional balloon angioplasty( PBA) in simple strategy. Methods: From Janunary 2009 to June 2013,218 consecutive patients with 233 bifurcation lesions( Duke D or F type) who received CBA or PBA with simple strategy were involved in a single center retrospective analysis. The process of operating,procedural success of PCI and PTCA,complications and the results of follow-up were investigated. Results: 73. 4% of 218 patients with 233 coronary bifurcation lesions were located in left anterior descending artery / the first diagonal branches,12. 0% in circumflex artery / obtuse marginal branches,and 14. 6% in right coronary artery / posterior descending artery or posterior lateral artery. The 122 patients who received CBA with simple strategy were involved in CB group. The other 96 patients who received PBA with simple strategy were involved in PB group. The procedural success of PCI was 100% in the CB group and 98. 1% in the PB group( P > 0. 05),but the procedural success of PTCA was higher in CB group than PB group( 92. 1% vs. 78. 3%,P< 0. 05). Perioperative complications( rate of perioperative myocardial infarction) was lower in the CB group than in the PB group( 4. 1% vs. 12. 5%,P < 0. 05). At the 12-month follow-up,the MACEs was 5. 31% in the CB group versus 14. 0% in the PTCA group( P < 0. 05). Conclusion: The procedure of CBA with simple strategy is safe and effective in treatment of bifurcation lesions.