分叉病变介入治疗中应用Jailed Balloon Technique与Jailed Wire Technique疗效对比

Comparison in curative effect between jailed balloon technique and jailed wire technique applied in percutaneous coronary intervention for coronary bifurcation lesion

目的：观察冠状动脉分叉病变（陈氏分型Ia）中拟行主支支架，分支必要时行支架置入术的患者中，应用Jailed Balloon Technique行经皮冠脉介入治疗（PCI）与传统的Jailed Wire Technique相比的安全性及有效性。方法选择2012年2月至2013年12月邢台市第三医院心内三科冠状动脉分叉病变类型属于陈氏分型Ⅰa型（除外左主干分叉病变）患者共108例，男性58例，女性50例，年龄45~70岁。所有患者均需主支置入支架，同时因边支闭塞风险高，需进行分支保护，必要时行分支支架置入术。随机分为两组：试验组（58例）应用Jailed Balloon Technique行PCI治疗；对照组（50例）应用Jailed Wire Technique行PCI治疗。在主支支架置入后，比较两组间边支夹层、闭塞的发生率、术中和术后主支以及分支TIMI3级比例、手术总时间、置入支架个数等。结果两组术中和术后主支TIMI3级比例、置入支架个数、术后6个月支架内再狭窄比例比较，差异无统计学意义（P均＞0.05）。与对照组比较，试验组术中和术后边支TIMI3级比例升高，球囊对吻比例、术中以及术后边支严重撕裂、夹层、狭窄严重或闭塞比例、置入边支支架比例、术后6个月边支狭窄加重及闭塞比例下降，平均手术时间减少，差异有统计学意义（P均＜0.05）。结论在冠状动脉分叉病变介入治疗中应用Jailed Balloon Technique保护分支，可改善患者血流，减少分支闭塞、夹层等发生，安全有效。

Objective To observe the safety and effectiveness of jailed balloon technique and jailed wire technique applied in percutaneous coronary intervention （PCI） in patients with coronary bifurcation lesion （Chen type Ia） who were proposed to undergo major branch stent implantation or side branch stent implantation if necessary. Methods The patients （n=108, male 58, female 50 and aged from 45 to 70） were chosen from Feb. 2012 to Dec. 2013, and randomly divided into test group （n=58） given PCI by jailed balloon technique, and control group （n=50） given PCI by jailed wire technique. After major branch stent implantation, the incidence of side branch dissection and occlusion, percentage of major or side branch grade-3 TIMI during and after operation, total operation time and number of implanted stents were compared between 2 groups. Results The comparison in percentage of major branch grade-3 TIMI during and after operation, number of implanted stents and percentage of in-stent re-stenosis had no statistical significance between 2 groups （all P〉0.05）. Compared with control group, the percentage of major or side branch grade-3 TIMI increased during and after operation, and percentages of kissing balloon, serious tear, dissection, severe stenosis and occlusion of side branch, implanted stents of side branch, and side branch severe stenosis and occlusion decreased, and average operation time decreased in test group （all P〈0.05）. Conclusion The application of jailed balloon technique during PCI for treating coronary bifurcation lesion can improve blood flow and reduce incidence of occlusion and dissection of side branch, which is safe and effective.