双导丝球囊治疗冠状动脉分叉病变的影响因素

Influential factors of efficacy of dual-wire balloon in treatment of coronary bifurcation lesions

目的：分析双导丝球囊治疗冠状动脉分叉病变中影像学效果的影响因素。方法：回顾性分析冠状动脉分叉病变210例,分别按照主支/边支血管参考直径、成角对边支血管即刻管径获得进行亚组分析。结果：球囊扩张主支血管后,在绝大多数病例中,双导丝球囊组边支血管即刻管径获得的绝对值比普通球囊组小（P〈0.05）。而在主支血管置入支架后,只有在主支血管狭窄程度最重的≥95%[-0.25±0.26）mm vs（-0.54±0.40）mm,P〈0.01]、边支血管参考直径较小的2.0-2.4mm[（-0.29±0.28）vs（-0.52±0.31）mm,P〈0.01]、边支血管狭窄程度相对较轻的〈50%[（-0.09±0.13）mm vs（-0.14±0.06）mm,P〈0.05]、主支和边支血管成角较小的〈70°[（-0.30±0.35）mm vs（-0.60±0.37）mm,P〈0.01]这部分病例中,可以观察到边支血管即刻管径获得的绝对值比普通球囊组小。结论：双导丝球囊用于分叉病变预处理可以在一定程度上减轻主支血管斑块向边支血管位移的程度,特别是对于主支血管狭窄程度较重、边支血管较细、边支血管狭窄程度较轻、Y型分叉病变,即便是在主支血管置入支架后仍然可以观察到双导丝球囊预处理分叉病变后的获益。

Objective： To analyze the influential factors of efficacy of dual-wire balloon in treatment of coronary bifurcation lesions. Methods： Two hundreds and ten coronary bifurcation lesions were enrolled retrospectively. Subgroup analysis of acute lumen diameter gain was carried out according to reference diameter and stenosis of main vessel / side branch and angulation between main vessel and side branch. Results： After predilatation,in most cases,acute lumen diameter gain of dualwire balloon were much smaller than that of conventional balloon（ P〈0. 05）. After stent implantation,only in the bifurcation lesions with main vessel stenosis ≥ 95% [（- 0. 25 ± 0. 26） mm vs（- 0. 54 ± 0. 40） mm,P〈0. 01],side branch reference diameter 2. 0 - 2. 4mm [（- 0. 29 ± 0. 28） mm vs（- 0. 52 ± 0. 31） mm,P〈0. 01],side branch stenosis 50% [（- 0. 09 ± 0. 13） mm vs（-0.14 ±0.06） mm,P〈0.05],angulation between main vessel and side branch 70 degree [（-0.30 ±0.35） mm vs（-0.60 ±0. 37） mm,P〈0. 01],were with significantly smaller absolute values of acute lumen diameter gain in dual-wire balloon group compared with that of conventional balloon group. Conclusions： Predilatation with dual-wire balloon could reduce plaque shift from main vessel to side branch,especially when the lesions of main vessel with much plaque burden,small side branch,almost normal diameter of side branch and Y-shape bifurcation lesion,less plaque shift in observed dual-wire balloon group even after stent implantation.