药物支架治疗冠状动脉分叉病变9个月随访研究

目的：探讨应用国产药物洗脱支架（DES）治疗分叉病变及主支及分支血管均植入药物支架（Stent／Stent）和主支血管植人药物支架、分支血管球囊扩张（Stent/PTCA）两种方法的临床疗效。方法：自2003年9月至2007年1月在我中心因心绞痛、陈旧性心肌梗死、无痛性心肌缺血行冠状动脉造影证实为自身冠状动脉分叉病变的患者242例，248处病变。分又病变的标准根据Lefevre的标准进行分类，主支血管及分支血管的直径均大于2．5mm。分叉病变的类型为前降支／对角支105例（42．3％）．左冠状动脉主干分又病变70例（28．2％），回旋支／钝缘支42例（16．9％）．右冠状动脉远端分叉病变31例（12．5％），处分叉病变中采用Crush技术28例，“T”型支架置入23例；Reverse T支架置入25例，改良“Y”型支架置入3例；对吻支架置入11例；“V”型支架置入1例和Culotte技术置入5例。其余152例（64．7％）使用cross over技术，共植入药物支架384枚，其中Firebird支架（上海微创公司）327枚，占84．5％。术前常规应用阿司匹林及波力维，术中应用普通肝素或低分子肝索抗凝。术后用药氯吡格雷75mg／d至少服用6个月，长期服用阿司匹林100mg／d。主要研究终点为术后及9个月内的MACE事件（心源性死亡、急性心肌梗死、支架内血栓形成、再次靶血管重建术）。结果：手术成功率为100％，住院期间无死亡，住院期间心脏事件发生率为0％，所有病例均完成了9个月的临床随访，随访期间死亡3例，其中心源性死亡2例，非ST段抬高心肌梗死3例，再发心绞痛13例，主要心脏不良事件7．4％。118例完成9个月的造影随访，随访率为44．5％，其中双药物支架组51例，主支支架组67例。11例发生了支架内再狭窄．其中双药物支架组5例，主支支架组6例，发生率分别为9．8％和9．0％，P〉0．05，总再狭?

Drug Eluting Stent Implantation for Bifurcation Coronary Artery Disease: Nine-Month angiographic Fellow-Up Clinical Outcome

Objective: To evaluate two different techniques of sirolimus-eluting stent placement in bifurcation lesions. Method: From september 2003 to Jan 2007, a total of 242 patients were treated with bifurcation lesions with two strategies: stenting both vessels (n =90) or stenting the main vessel and balloon angioplasty of the side branch (n=152). Clinical and angiographic follow-up was obtained nine months later. Results: PCI procedure for the bifurcation lesions in the two group were 100% successed. Stent placement on both branches resulted in a lower residual stenosis (7.4 6 10.9% vs.23.4% 6 18.7%, p, 0.001) in the side branch. Acute procedural success was similar in the two groups (group B: 87% vs. Group P: 92%).No in-hospital major adverse cardiac events (MACE) occurred in both group . At the nine-month follow-up, the angiographic restenosis rate (group B: 62% vs. Group P: 48%) were similar in the two groups. There was no difference in the incidence of nine-month total MACE (51% vs. 38%). Conclusions: For the treatment of true bifurcation lesions, the DES is safe and feasible .A complex strategy of stenting both vessels is a selective method compare with a simpler strategy of stenting only the main vessel.