优化的Culotte术式在冠状动脉真性分叉病变中的应用

目的：探讨在Culotte技术中优化再导丝化操作（Re-wire）,对真性冠状动脉分叉病变中应用的安全性和有效性。方法：研究入选冠状动脉造影证实的Medina分型,1,1,1型分叉病变患者146例,其中78例接受传统Culotte术式治疗（传统组）,68例接受优化Culotte术式（优化组）。随访12个月,并于术后9-12个月复查冠状动脉造影,观察入选患者的临床基本特征、手术操作特征、冠状动脉脉造影随访及12个月的临床随访结果。结果：两组手术成功率和最终对吻球囊扩张率均为100%,在病变处理时间和造影剂用量上两组结果相似,差异无统计学意义（P〉0.05）。共有109例患者完成冠状动脉造影随访。与传统组相比,优化组分支支架内晚期管腔丢失（LLL）明显降低[（0.32±0.30）vs.（0.20±0.23）mm,P=0.01],分支开口LLL也明显降低[（0.34±0.38）vs.（0.22±0.31）mm,P=0.02],分支支架内再狭窄率有降低的趋势（10.9%vs.1.8%）,但差异无统计学意义（P=0.11）。两组患者随访期间的主要不良心脏事件和支架内血栓的发生率分别比较,差异均无统计学意义（P〉0.05）。结论：优化Re-wire操作明显降低了Culotte技术在分叉病变分支支架内和分支开口的晚期管腔丢失,取得了良好的长期临床疗效,手术成率高,同时并未明显延长病变处理时间。

Necessity and proper way of intermediate kissing balloon dilation for culotte stenting: further insights from bench testing

Objective: The aim of this study was to investigate whether intermediate kissing balloon dilation(IKBD) is necessary during mini-culotte stenting(MCS) and how it can be properly conducted. Methods: MCS was emulated in a bifurcation model with a branch diameter difference(BDD) in three-step sizes of 0.50, 0.75 and 1.00 mm, and with intermediate balloon dilation(IBD) in three treatments of routine intermediate solo balloon dilation(rISBD), concurrent IKBD(cIKBD) or sequential IKBD. Microcomputed tomography was performed to assess stent under-expansion(SUE) around the polygon of confluence(POC), residual ostial stenosis(ROS) at the ostial side-branch(SB) and main-branch(MB) and stent cell distortion(SCD) in the bifurcation segments. Results: There were both main and interactive effects of IBD and BDD on ROS at the ostial SB and SCD in the ostial SB, but there were only main effects of IBD or BDD on SUE around the POC, ROS at the ostial MB and SCD in the ostial MB. Analysis of the main effects showed that SUE around the POC or ROS at the ostial SB was significantly different between sI KBD and rISBD and between cI KBD and rISBD. There was also a significant difference in SCD in the ostial SB between sI KBD and rI SBD and between sI KBD and cIKBD. Analysis of the interactive effects showed that ROS at the ostial SB or SCD in the ostial SB was affected by all IBD treatments in all BDD step-sizes. Moreover, increasing the BDD step-sizes significantly increased ROS at the ostial SB as treated by rISBD and SCD in the ostial SB as treated by rISBD or cIKBD. Conclusions: SIKBD was shown to be essential and superior to rISBD or cIKBD, resulting in better bifurcated stent expansion and coverage when using MCS.

Culotte技术与T型支架置入治疗分叉病变的比较:短期临床和血管造影结果以及中期临床随访

背景:对主血管予支架置入,同时对侧支(SB)行临时支架置入是大多数分叉病变选用的方法。Culotte技术和T型支架置入是适于分叉病变临时支架置入的两种治疗技术,当前关于两种技术中哪一种效果更好尚缺乏研究资料。方法:在2004年2月至2005年10月间,

DK-Culotte技术处理冠状动脉分叉病变的临床疗效观察

目的:观察双对吻扩张Culotte(DK-Culotte)术式在经皮冠状动脉介入治疗处理分叉病变中的可行性及有效性。方法:选择42例LefevreⅠ型分叉病变患者,利用药物洗脱支架给予DK-Culotte术式进行介入治疗。观察最终球囊对吻扩张(FKBI)的成功率和即刻的介入效果,并在术后1、3、6、12个月进行门诊或电话随访,观察主要心血管不良事件(包括心源性死亡、心肌梗死和再次血运重建)的发生率。结果:所有患者的分叉病变(包括主支和分支)均成功利用DK-Culotte术式进行了介入治疗,FKBI的成功率为100%。术后即刻造影效果满意,病变狭窄程度较术前显著减轻[主支:术后(12.4±5.3)%∶术前(78.2±8.2)%;分支:术后(13.7±6.8)%∶术前(83.5±9.1)%;均P<0.05],主支及分支均达到TIMI 3级血流。术后随访12个月,无主要心血管不良事件发生。结论:DK-Culotte术式可以明显提高FKBI的成功率,在经皮冠状动脉介入治疗处理分叉病变中具有一定的可行性、有效性和安全性。