分叉病变不同处理方法的疗效观察

Effects of different methods in treating bifurcation lesion after drug eluting stent implantation in the main branch

目的观察比较应用药物支架治疗分叉病变时对开口狭窄的分支血管的不同处理方法（即支架治疗、单纯球囊扩张和不处理分支）的疗效。方法入选93例主支血管药物支架置入术后引起直径≥2．0mm分支血管开口狭窄大于50％的、于术后6～12个月间接受冠状动脉造影随访的患者，根据分支血管采取的不同治疗方法分成3组，即主支和分支血管均置入支架组（简称支架组）、主支置入支架、分支血管单纯球囊扩张组（简称球囊扩张组）和主支置入支架、分支未处理组（简称未处理组）。观察分支血管开口狭窄程度变化及主要不良心血管事件发生情况。结果于术后6～12个月接受冠状动脉造影复查随访时，虽然分支开口狭窄程度在支架组和球囊扩张组仍优于未处理组（三组分别为40．21％，40．76％和80．23％；P〈0．001），但三组间主支血管再狭窄率和主要不良心血管事件发生率差异无统计学意义（三组主支血管再狭窄率分别为33．33％，25．00％和12．50％；P=0．085；主要不良心血管事件发生率分别为38．10％，29．17％和25．00％；P=0．523）。结论对支架置入后开口狭窄的分支血管采取积极的处理方法（如支架置入、单纯球囊扩张）同未处理组相比，并没有改善远期临床预后。

Objective To evaluate the effects of different methods in treating bifurcation lesion with drug eluting stentts （DES）. Methods Ninety three patients who had bifurcation lesion and received 6-12 months angiographic follow up after DES implantation were included in this study. All the patients had implanted at least one drug eluting stentt in the mian branches which resulted in side branches （diameter≥2. 0 mm） ostial stenosis （ 〉 50% ）. All the patients were catagorized into 3 groups according to the intervention （ stenting, PTCA or no touch） applied in the side branches and the clinical outomes of the three different groups were compared. Results Among the 93 patients, 21 patients received stenting and 24 patients received balloon angioplasty in the side branches. No intervention was given in 48 patients. Although patients in the stenting group and the PTCA group could maintain a greater vessel lumen in the side branches compared with patients without intervention （40. 21%, 41.76% and 80. 23%, P 〈 0. 001, in terms of percentage of stenosis respectively）, there were no significant differences among the three groups in restenosis rate in the main branches （33.33% ,25.00% and 12. 50% ,P =0. 085） and MACE （38. 10%, 29. 17% and 25. 00% ,P = 0. 523）. Conclusion Progressive treatments of the stenosed side branches after DES implantation in the main branches do not provide significant long term clinical benefits.