应用双药物洗脱支架治疗分叉病变的近期临床疗效

目的探讨应用双药物洗脱支架（DES）治疗分叉病变的临床近期疗效。方法自2003年10月至2005年2月入选应用双DES治疗分叉病变患者71例,72处病变。分叉病变的类型为前降支／对角支45例（62．5％）,左冠状动脉主干分叉病变20例（27．8％）,回旋支／钝缘支6例,右冠状动脉远端分又病变1例。72处分叉病变中采用Crush技术42处,包括标准Crush技术16处和改良Crush26处;“T”型支架置入19处;改良“Y”型支架置入5处;“V”型支架置入3处和Culotte技术3处。结果入选71例患者中男性59例（83．1％）,女性12例,平均年龄57岁。72处分叉病变中（144处病变）使用Cypher或Cypher Select DES 59个,TAXUS DES48个,Firebird DES 25个和金属裸支架24个。72处分叉病变置入双支架后60处（83．3％）完成了对吻球囊扩张技术。手术成功率为100％。住院期间1例发生亚急性血栓致急性心肌梗死（AMI）,再次经皮冠状动脉介入治疗成功。住院期间主要心脏不良事件（MACE,包括死亡、AMI、再次血管重建）发生率为1．4％（1／71）。71例中16例完成了6个月的临床随访,无死亡和AMI发生,1例6个月时冠状动脉造影显示对角支口部完全闭塞,随访期间MACE发生率为6．3％（1／16）。结论本研究结果显示对于分支口径〉2．5mm且口部有严重狭窄性病变的分叉病变,采用双DES治疗是安全的,近期临床疗效十分满意,远期临床疗效初步显示也是满意的,但仍有待进一步证实。

Clinical outcomes of treating bifurcation lesions with two drug-eluting stent techniques

OBJECTIVE: To evaluate the clinical outcomes of treating bifurcation lesions with two drug-eluting stent (DES) techniques. METHODS: From October 2003 to February 2005, Seventy-one patients with 72 bifurcation lesions (the ostium of side branch > 2.5 mm in diameter) were treated by two DES. Forty-five of the bifurcation lesions were located in LAD/Diagonal (62.5%), 20 in distal left main coronary arteries (27.8%), 6 in LCX/OM (8.3%) and 1 distal RCA (1.4%). The Crush or modified Crush technique was used in 42, "T" technique in 19, modified "Y" technique in 5, "V" technique in 3 and Culotte technique in 3 bifurcation lesions, respectively. Fifty-nine Cypher or Cypher Select stents, 48 TAXUS stents, 25 Firebird stents and 24 bare metal stents were used for 144 lesions. Final kissing balloon inflation was performed in 60 bifurcation lesions (83.3%) after stenting procedure. RESULTS: Success rate of PCI procedure for the bifurcation lesions was 100%. One patient developed subacute stent thrombosis and underwent successful urgent revascularization. In-hospital major adverse cardiac events (MACE, death, AMI, revascularization) rate was 1.4% (1/71). Six months follow-up was made in 16 patients. No death and AMI occurred during the follow-up period in these patients. Total occlusion in ostium of the diagonal vessel was found in one patient with LAD/Diagonal bifurcation lesion 6 months post procedure. MACE rate during the follow-up was 6.3% (1/16). CONCLUSION: This study showed that the use of two DES techniques for the treatment of bifurcation lesions was safe and effective. The short-term outcome for this strategy was very satisfactory and primary data of 6-month follow-up also showed satisfactory results.