预留小球囊对冠状动脉分叉病变中分支的保护作用

Protection effect of setting aside small balloon on coronary bifurcation lesions

目的采用单支架策略治疗冠状动脉分叉病变，探讨预留小球囊对分叉病变中重要分支的保护作用。方法将50例冠状动脉分叉病变患者随机分为两组，A组（25例）在分支内预置入保护导丝，完成主支球囊预扩张、支架置入；B组（25例）在分支内预留小球囊，同样完成主支球囊预扩张、支架置入。比较两组分支血流明显减慢的发生率、分支闭塞或置入支架的发生率以及术后24h肌钙蛋白I（cTnI）水平明显升高者比例。结果A组25例中9例发生分支血流明显减慢（36％），其中置入支架4例（16％），完全闭塞2例（8％）；B组25例中2例发生分支血流明显减慢（8％），无闭塞或置入支架（P值分别为0．041、0．022）；术后24hcTnI明显升高例数，A组11例（39％），B组3例（12％）（P=0．027）。结论与传统保护导丝相比较，预留小球囊保护重要分支，能够有效防止重要分支闭塞，降低分支受累所致心肌梗死的发生率。

Objective To explore the protective effect of a small balloon on bifurcation lesions by applying a single stent treatment of coronary bifurcation lesions strategy. Methods Fifty patients with coronary bifurcation lesions were randomly divided into A group and B group （25 cases for each group）. Patients in A group were treated with the pre-entry protection branch guide wire to complete the main branch balloon pre- dilation, stenting, while in B group were treated with the set aside the branches of a small balloon. The information of main branch balloon pre-dilation, stenting were recorded. The blood flow slowed down, the incidence of side branch occlusion or stent placement, and the incidence of postoperative 24 h troponin I （cTnI） levels were measured. Results Nine eases（36% ） in A group occurred lower branch blood flow,which due to 4 cases（ 16% ） with significantly narrow branch stenting,2 cases （8%） with complete occlusion. There were only 2 cases（ 8% ） with decrease branching blood flow in B group, and the difference was significant（ P = 0. 041, 0.022）. The cases with higher cTnI after 24 h in A group were 11 （39%）,significantly higher in group B （ 3 （ 12 % ） ; P = 0. 027 ）. Conclusion Compared with the traditional protection guidewire, the approach of setting aside a small balloon to protect important branch can effectively prevent important branch occlusion, branch involvement due to lower incidence of myocardial infarction.