不同双支架技术治疗急性冠脉综合征患者左主干分叉病变后的左前降支TIMI血流变化

Effect of different stents approaches on TIMI blood flow of left anterior descending in acute coronary syndrome patients with left main bifurcation disease

目的探讨4种不同双支架技术(Crush、Culotte、T、TAP)治疗急性冠脉综合征(acute coronary syndrome,ACS)患者左主干(left main,LM)分叉病变(left main bifurcation disease,LMBD)后的左前降支(left anteriordescending,LAD)心肌梗死溶栓试验(thrombolysis in myocardial infarction,TIMI)血流分级变化。方法入选2010年1月至2014年12月在广东省人民医院诊断为ACS合并LMBD并接受双支架技术介入治疗的患者,根据采用双支架技术的不同,将患者分成4组,分别是Crush组、Culotte组、T组、TAP组。通过检测术后LAD的TIMI血流的变化情况,来判断各组技术的相对优劣。结果 Logistic回归分析发现LM-LAD直径是双支架技术的危险因素;而LM-左旋支(left circumflex,LCX)直径和LM支架总长度是保护因素。Culotte组术后LAD的TIMI血流改善情况明显差于其他3组,差异有统计学意义(P>0.05);而其他3组之间比较,差异无统计学意义(P>0.05)。结论不同双支架技术对患者术后LAD血流的改善程度有差异,Culotte技术改善LAD的TIMI血流效果比TAP、T和Crush技术差,TAP、T和Crush技术之间比较无显著差异。

Objectives To investigate the effect of different stents approaches（Crush,Culotte,T,TAP）on leftanterior descending（LAD） thrombolysis in myocardial infarction（TIMI） blood flow in acute coronary syndrome（ACS）patients with left main（LM）bifurcation disease（LMBD）after percutaneous coronary intervention（PCI）.Methods From January 2010 to December 2014,a total of 157 ACS patients with LMBD were investigated inGuangdong General Hospital. The patients were divided into 4 groups by the different interventional operations asCrush,Culotte,T and TAP approaches. LAD TIMI blood flow was measured to judge the advantage of the approaches.Results Logistic regression analysis indicated that,among the 157 patients,the diameter of LM-LAD was the riskfactor in ACS patients with LMBD,however,the diameter of LM-left circumflex（LCX）and the total stent length ofLM shown beneficial effects. Culotte approach was worse than the other approaches to improve TIMI blood flow of LADafter PCI. Conclusions Culotte approach is worse than other approaches such as TAP,T or Crush to improve TIMIblood flow of LAD after PCI.