小外径球囊代替保护导丝完成冠脉分叉病变的临床分析

目的 比较小外径球囊与传统保护导丝,预留于分支血管完成冠脉分叉病变支架置入术的效果.方法 比较53例冠脉分叉病变,随机分为两组：A组（26例）放置保护导丝于分支内,完成主支内球囊预扩,支架置入,交换导丝后主支与分支球囊对吻;B组（27例）放置小外径球囊于分支内,低压力打开球囊下,同样完成主支支架置入及交换导丝后主支与分支球囊对吻.比较两组间分支闭塞的发生率、分支开口狭窄明显加重的发生率及完成交换导丝和球囊对吻的时间.结果 A组3例（11.5%）发生分支闭塞;B组0例发生分支闭塞,P＜0.05.分支开口狭窄明显加重的发生率,A组7例（26.9%）,B组2例（7.4%）,P＜0.05.完成交换导丝和球囊对吻的时间,A组（45.0±12.3）min,B组（12.0±10.3）min,P＜0.05.结论 利用小外径球囊代替保护导丝放入边支或重要分支,低压力打开球囊,完成冠脉分叉病变主支支架置入,可以明显减少边支的丢失,预防分支开口狭窄明显加重,同时交换导丝及球囊对吻顺利,缩短了手术时间,提高了手术的安全性.

The clinical analysis of using small-diameter balloon instead of protection wire to complete bifurcation lesions

Objective Relatively small-diameter balloon with the traditional protection wire, reserved the branch vessel for completion of stenting of bifurcation. Methods 53 cases with bifurcation lesions were randomly divided into two groups, A group （n=26） guide wire in branch, then pre-expansion of the main branch balloon and planted stent, guide wire exchanged, and then finished by the Kissing balloon. B group （n=27）, place a small-dlameter balloon on the branch, low-pressure to open, the same main branch stent placement and completed the exchange guide wire, and then finished by the kissing balloon. The effects between two groups were compared. The incidence of the branch occlusion, stenosis of branch openings and the time to complete the exchange of guide wire and kissing balloon were compared. Results A group, 3 cases （11.5% ） had a branch occlusion, B group, 0 cases of branch occlusion, P〈0.05. The stenosis rate of opening was significantly increased in A group, （7 cases, 26.9% ） than B group（2 patients, 7.4% ）, P〈0.05. The time to complete the kissing balloon was significantly longer in A group （45.0±12.3）min than B group （12.0±10.3）min, P〈0.05. Conclusion Small-diameter balloon, instead of protection wire into the side branch, low-pressure opening balloon, completion of the main branch stenting in bifurcation lesions, can significantly reduce the loss of side branch, prevent the stenosis of branch openings, shorten the time of exchange guide wire and kissing balloon, and improve the safety of operation.