单环Culotte支架术处理真性冠状动脉分叉病变

Mono-ring culotte stenting for true coronary bifurcation lesions

目的介绍一种新型改良的裙裤(Culotte)技术处理真性冠状动脉分叉病变的初步临床经验。方法纳入2014年6月至2015年3月于福建医科大学附属协和医院采用单环Culotte支架术处理的15例真性冠状动脉分叉病变患者。记录患者手术时间、X线透视时间、对比剂用量,定量分析患者病变长度、术前和术后即刻最小管腔直径、参考血管直径及直径狭窄百分比,观察院内主要不良心血管事件(MACE)发生率。结果手术成功率为100%,未见手术并发症和院内MACE发生。手术时间为(34.3±9.6)min,X线透视时间为(18.1±3.8)min,对比剂用量为(112.0±24.5)ml。术前主支病变长度[(26.5±11.2)mm比(12.2±4.8)mm,P=0.001]、参考血管直径[(3.44±0.60)mm比(2.77±0.43)mm,P<0.001]和直径狭窄百分比[(80.8±11.8)%比(70.3±12.6)%,P=0.002]显著大于边支血管,而最小管腔直径显著小于边支血管[(0.64±0.36)mm比(0.82±0.35)mm,P=0.044];术后主支参考血管直径[(3.54±0.67)mm比(2.90±0.49)mm,P<0.001]和最小管腔直径[(3.18±0.61)mm比(2.61±0.46)mm,P<0.001]均显著大于边支血管,而直径狭窄百分比差异无统计学意义[(10.0±2.5)%比(10.2±5.3)%,P=0.932]。结论单环Culotte支架术安全易行,或许优于传统的Culotte支架术。

Objective To report our first clinical experience with a novel modified culotte technique for the treatment of true coronary bifurcation lesions. Methods The novel modified culotte technique（ the mono-ring culotte） stenting was done in which the side branch（ SB） stent was deployed firstly followed by ex vivo wiring of a most proximal cell of SB stent with the hard end of main branch（ MB） wire. Secondly,the MB stent was deployed through the most proximal cell of SB stent. The procedure was ended with kissing balloon dilation. From June 2014 to March 2015,15 patients with true coronary bifurcation lesion were treated with mono-ring culotte stenting in our center. Results The procedures were successful in all cases without procedural complication and in-hospital major adverse cardiovascular events. The procedural time was（ 34. 3 ± 9. 6） min,fluoroscopic time was（ 18. 1 ± 3. 8） min,and contrast volume was（ 112. 0 ±24. 5） ml,respectively. Post-procedurally,the residual stenosis of the main and the side branch were（ 10. 0± 2. 5） % and（ 10. 2 ± 5. 3） %,respectively. Conclusions The mono-ring culotte stenting is safe and feasible for treatment of true coronary bifurcation lesions,and may be superior to the conventional culotte stenting.