药物洗脱支架年代无保护左主干病变血运重建策略的选择

Strategy of Unprotected Left Main Coronary Artery Revascularization in Drug-eluting Stent Era

冠状动脉旁路移植术一直被认为是治疗无保护左主干病变的金标准。近年来,由于经皮冠状动脉介入治疗技术及器械的迅速发展,特别是药物洗脱支架的广泛应用,使冠状动脉介入治疗术后由再狭窄导致的再次靶病变血运重建率明显降低,经皮冠状动脉介入治疗无保护左主干病变研究以及和冠状动脉旁路移植术疗效对比研究越来越多,并且显示药物洗脱支架对无保护左主干病变有良好的疗效,其安全性与冠状动脉旁路移植术相似,甚至在某些方面具有优势。现就近年来冠状动脉旁路移植术和冠状动脉介入治疗无保护左主干病变的研究进展做一综述,探讨在药物洗脱支架年代无保护左主干病变治疗策略的选择。

Coronary artery bypass grafting has been considered the standard treatment of unprotected left main disease. In recent years, due to the rapid development of percutaneous coronary interventional treatment technology and deviees, especially the wide applicationof drug-eluting stent, the rate of restenosis decreased significantly, the clinic study between percutaneous coronary intervention and coronary artery bypass transplantation for unprotected left main disease suggests that drug-eluting stents has good effects on unprotected left main dis- ease. It is safe comparing with coronary artery bypass graft surgery, even has advantages in some aspects. This paper makes a review of the recent progress in research on coronary artery bypass grafting and pereutaneous coronary intervention for unprotected left main coronary artel-y disease, and discusses the strategy of unprotected left main coronary artery revascularization in the drug-eluting stent era.