简单和复杂支架技术治疗主要冠状动脉分叉病变的临床疗效

Effectiveness of Stent Implantation Using Simple or Complex Strategy for the Treatment of Major Coronary Bifurcation Lesions

目的 比较简单支架技术与复杂支架技术治疗主要冠状动脉分叉病变的临床疗效。方法 自 1998年 1月至 2 0 0 2年 6月间我院共完成 38例主要冠状动脉分叉病变。其中 2 8例采用对吻球囊技术对主支和边支预扩张 ,仅主支内植入支架为简单支架术A组 ;10例采用“T型”或“Y型”支架技术 ,分别在边支和主支均植入支架为复杂支架术B组。随访 6个月以上 ,记录主要不良心脏病事件 (心绞痛、急性心肌梗死、急诊搭桥、心源性死亡 )。结果 两组患者之间基础临床情况及造影血管特征无显著差异。A组主支成功率为 10 0 %,边支成功率为 89.3%(2 5 /2 8例 ) ,3例边支因残余狭窄 >5 0 %,随即植入支架获得成功 ;B组支架成功率为 10 0 %,3例因边支在球囊扩张后残余狭窄轻 ,主支植入支架后边支残余狭窄 <5 0 %,未植入支架。随访期间A组再发心绞痛 5例 (5 /2 8,17.8%) ,B组再发心绞痛 2例 (2 /7,2 8.6%) ,两组均无其他主要不良心脏事件发生。

Objective: To evaluate the effectiveness of intracoronary stent implantation using simple or complex strategy for the treatment of major coronary bifurcation lesions.Methods: A total of 38 patients with coronary artery bifurcation lesion treated with stenting between January 1998 and June 2002 in our lab. In group A (n = 28), a simple approach (the bifurcation lesions were pre-dilatated with the kissing balloon technique and then stents were implanted only in the main branch) was pursued. In the other group (group B, n = 10), both the main vessel and the side branch were stented using 'T' stenting technique or 'Y' stenting technique. The follow-up lasted at lest 6 months and major adverse cardiac events (including angina, acute myocardial infarction emergence CAGB, and cardiac death) were recorded.Results: There was no significant difference in baseline data including clinical and angiographic characteristics between two groups. Angiographic success was 89.3% (25/28) in the side branches and 100% in the main branch in A group. Three patients presented a residual stenosis >50% in the side branch and the lesions were successful stented subsequently. Angiographic success was 100% in the all the branches in B group. During the follow-up, unstable angina was developed in 5 (17.8%) patients in A group and in 2 (28.6%) patients in B group. No other major adverse cardiac events occurred in both group.Conclusions: For the treatment of major coronary bifurcation lesions, a complex strategy of stenting both branches provided no advantage versus a simpler strategy of stenting only the main branch.