双导丝球囊在冠状动脉分叉病变中的应用

Application of dual-wire balloon in coronary bifurcation lesions

目的:观察双导丝球囊在冠状动脉分叉病变应用中的有效及安全性。方法:本研究入选210例冠状动脉分叉病变患者,随机分为双导丝球囊组和普通球囊组。用定量冠状动脉造影的方法分别测量了术前、球囊扩张后、支架置入后分叉部位最小管腔直径、即刻管径获得和直径狭窄率。结果:研究的有效性指标,在球囊扩张后,使用双导丝球囊的病例与使用普通球囊的病例相比,前者边支血管的直径狭窄率更低[(43.38±16.81)vs.(51.68±15.01)%,P<0.01]、最小管腔直径更大[(1.34±0.47)vs.(1.15±0.39)mm,P<0.01]、即刻管径获得的绝对值更少[(-0.11±0.04)vs.(-0.25±0.09)mm,P<0.01],差异均具有统计学意义。170例患者在球囊扩张主支血管后置入了支架。双导丝球囊组与普通球囊组相比,前者边支血管的直径狭窄率更低[(50.34±16.82)vs.(66.09±22.60)%,P<0.01]、最小管腔直径更大[(1.14±0.40)vs.(0.93±0.34)mm,P<0.01]、即刻管径获得的绝对值更少[(-0.30±0.12)vs.(-0.54±0.19)mm,P<0.01],差异均具有统计学意义。安全性指标,血管夹层、边支闭塞、主要不良心血管事件发生率在两组间无明显差异。结论:用双导丝球囊扩张主支血管,边支血管受到的影响相对较小,这可能和导丝切割斑块的作用有关。双导丝球囊可能成为分叉病变介入治疗中的一种选择。

Objective： To observe the effectivity and safety of dual-wire balloon applied in coronary bifurcation lesions. Methods： 210 patients with coronary bifurcation lesions were enrolled and accepted predilation with dual-wire balloon or ordinary balloon randomly. Minimal lumen diameter,acute lumen diameter gain and diameter stenosis were measured by quantitative coronary analysis before dilation,after dilation and after stent implantation respectively. Results： For the effective indicators,after predilation,the patients with dualwire balloon had less serious stenosis[（ 43. 38% ± 16. 81%） vs.（ 51. 68% ± 15. 01%）,P〈0. 01 ],larger minimal lumen diameter [（ 1. 34 ± 0. 47） mm vs.（ 1. 15 ± 0. 39） mm,P〈0. 01] and smaller absolute value of acute lumen diameter gain[（- 0. 11 ± 0. 04） mm vs.（- 0. 25 ± 0. 09） mm,P〈0. 01],compared with ordinary balloon group. 170 patients accepted stent implantation after predilation. After stent,the patients with dualwire balloon had less serious stenosis[（ 50. 34% ± 16. 82%） vs.（ 66. 09% ± 22. 60%）,P〈0. 01 ],larger minimal lumen diameter[（ 1. 14 ± 0. 40） mm vs.（ 0. 93 ± 0. 34） mm,P〈0. 01] and smaller absolute value of acute lumen diameter gain[（- 0. 30 ± 0. 12） mm vs.（- 0. 54 ± 0. 19） mm,P〈0. 01],compared with ordinary balloon group. Conclusions： Dual-wire balloon might be alternative as less plaque shift from main vessel to side branch.