Firebird治疗无保护左主干病变的近中期疗效

Midterm curative efficacy of domestic drug eluting coronary stent in treatment of left main lesion

目的了解国产药物涂层支架(Firebird,微创)治疗左主干病变的的近中期疗效。方法抢救中心在2004年4月至2005年9月共有32例无保护左主干病变(LMCA)患者进行了PCI治疗,共植入Firebird支架(微创)39枚。对左主干开口和干段不累及远端分叉病变仅植入1枚支架;对于远端分叉病变选择T支架、通过LCX开口支架、对吻支架术。患者出院后1、6、12个月进行随访,造影随访5～10个月。观察国产药物涂层支架在LMCA病变中心性死亡、再狭窄、靶病变的重建率(TLR)、靶血管的重建率(TVR)等临床情况。结果LMCA病变中以远端分叉病变占大多数为53.1%,处理LMCA的分叉病变策略,本研究多为T支架术(47%),其次为支架通过LCX开口(35.3%)。LMCA开口和干段病变行PCI长期随访无一例再狭窄。本组研究造影随访率为62.3%,再狭窄率5%,TLR 5%,TVR 10%,心性死亡6.3%。结论低危的无保护左主干病变药物洗脱支架的植入可以获得满意的临床疗效。

Objective To study midterm curative effect of domestic drug eluting coronary stent in treatment of left main （LM） lesion. Method From April 2004 to September 2005, totally 32 patients with LM lesion received pereutaneous coronary intervention （PCI） without protection. Thirty-nine coronary stents （Firebird, Microport, Shanghai） were implanted. One stent was used when the lesion only involved the opening or the middle portion of the LM branch. If the bifurcation was involved, the stenosis was treated considering the following factors： the diameter of left main, left anterior descending （LAD） and the left circumflex branch （LCX） ; whether there was stenosis of the opening of circumflex branch. Methods included ＂T＂ stent, stent pass though the opening of circumflex branch and kissing stents. All patients were followed at 1, 6 and 12 months after discharge. Coronary angiography of patients was performd at 5 months after discharge. Central necrosis, restenosis, target vessel reconstructive rate （TVR） and target lesion reconstructive rate （TLR） were analyzed. Results Most LM lesion involved bifurcation （53.1%） . Treatment for bifurcation included ＂T＂ stent in 47% patients, stent passing through the opening of LCX in 35.3%. No restenosis occurred in lesion involving the opening or middle portion of the LM during follow-up. The 62.3% patients received coronary angiography. Angiography showed 5% of restenosis rate, 5% TLR, 10% TVR and 6.3% central necrosis rate. Conclusions Drug eluting stent implantation in low risk unprotective left main lesion may achieve satisfactory chnical results.