雷帕霉素洗脱支架治疗无保护冠状动脉左主干严重狭窄性病变的安全性和远期效果研究

The Security and Long-term Outcomes of Rapamycin-eluting Stent Implantation in the Treatment of Unprotected Left Main Coronary Artery Severe Stenosis

目的评价雷帕霉素洗脱支架治疗无保护冠状动脉左主干(ULMCA)严重狭窄性病变(狭窄程度≥90%)的安全性和远期效果。方法选取我院2007年5月—2011年10月收治的43例ULMCA严重狭窄性病变患者,均植入雷帕霉素洗脱支架治疗。其中41例为急性冠脉综合征(26例为不稳定性心绞痛,15例为非ST段抬高型心肌梗死),2例为急性ST段抬高型心肌梗死。术式:左主干病变同时累及左前降支(LAD)和回旋支(LCX)18例(41.9%),其中10例采用Culotte stenting术式,8例采用Crush stenting术式;左主干病变累及LAD口和LAD近端11例(25.6%),其中5例应用Crossover stenting术式,6例应用Crush stenting或Culotte stenting术式;左主干病变累及LCX口和LCX近端7例(16.3%),其中3例应用Crossover stenting术式,4例应用Crush stenting或Culotte stenting术式;单纯左主干口狭窄4例(9.3%)和左主干中段狭窄3例(7.0%)应用了单支架技术。应用Culotte stenting、Crush stenting、Crossover stenting技术的患者最终全部完成了Final kissing balloon技术。统计患者手术成功率及住院和随访期间的主要不良心血管事件(MACE)发生率。结果 43例患者共植入雷帕霉素洗脱支架83枚,术后所治疗的病变残余狭窄<10%,手术成功率为100.0%(43/43);住院期间无MACE发生。随访14～67个月,平均随访(37.2±17.2)个月,此期间冠状动脉造影(CAG)随访13例(30.2%)。随访期间发生MACE 3例(2例死亡,1例极晚期支架内血栓),累计MACE发生率为7.0%(3/43)。CAG复查的13例中,极晚期左主干管腔丢失0～30%,平均管腔丢失(18.5±10.3)%。结论雷帕霉素洗脱支架治疗ULMCA严重狭窄性病变成功率高,且安全,MACE发生率较低,远期效果好。

Objective To evaluate the security and long-term outcomes of rapamycin-eluting stent implantation in the treatment of unprotected left main coronary artery(ULMCA) severe stenosis(stenosis degree≥90%).Methods From May 2007 to October 2011,43 patients with ULMCA severe stenosis were treated by rapamycin-eluting stent implantation,among whom 41 cases had acute coronary syndrome(26 cases of unstable angina pectoris,15 cases of myocardial infarction without ST segment elevation),2 cases had acute myocardial infarction with ST segment elevation.Of 18 cases(41.9%) with ULMCA severe stenosis,left anterior descending artery(LAD) and left circumflex artery(LCX) were also involved,among whom 10 cases were operated by Culotte stenting method,8 cases were operated by Crush stenting method.Of 11 cases(25.6%) with ULMCA severe stenosis,the LAD orifice and proximal LAD were also involved,among whom 5 cases were operated by Crossover stenting method,6 cases were operated by Crush stenting or Culotte stenting method.Of 7 cases(16.3%) with ULMCA severe stenosis,the LCX orifice and proximal LCX were also involved,among whom 3 cases were operated by Crossover stenting method,4 cases were operated by Crush stenting or Culotte stenting method.Four cases(9.3%) had simple ULMCA stenosis,and 3 cases(7.0%) had ULMCA middle segment stenosis,the above 7 cases were operated by one stent implantation method.All cases who were operated by Culotte stenting,Crush stenting and Crossover stenting method,were also treated with final kissing balloon technique.Surgery success rates and major adverse cardiac events(MACE) incidences during hospitalization and follow-upperiod were calculated. Results A total of 83 rapamycin- eluting stents were implanted in 43 cases,the degree of residual stenosis was < 10%,surgery success rate was 100. 0%( 43 /43),no MACE occurred in all cases. The follow- up period were 14～ 67 months,the average follow- up period were( 37. 2 ± 17. 2) months. Among 13 cases( 30. 2%) who received coronary angiography( CAG) during period of follow- up,late lumen loss rate of left main coronary artery was 0 ～ 30%,the average lumen loss rate was( 18. 5 ± 10. 3) %. MACE occurred in 3 cases during period of follow- up( 2 cases of death,1 case of late stent thrombosis),incidence of MACE was 7. 0%( 3 /43). Conclusion Rapamycin- eluting stent implantation in the treatment of ULMCA severe stenosis has a high success rate,incidence of MACE is low,security and long- term outcomes are satisfactory.