冠状动脉分叉病变介入治疗DK Crush技术与经典Crush技术疗效比较

目的 探讨DK Crush技术与经典Crush技术治疗冠状动脉分叉病变的临床价值。方法 选择该院2019年6月—2020年6月收治的冠状动脉分叉病变患者66例为研究对象,随机数表法均分为研究组和对照组,各33例。研究组行DK Crush技术治疗,对照组行经典Crush技术治疗。比较两组治疗效果。结果 研究组手术中造影剂总量少于对照组,PCI耗时高于对照组,球囊数量少于对照组,FKBI优于对照组,差异有统计学意义(t=6.166、7.385、10.667,χ^(2)=16.189,P<0.05)。对照组手术后5例发生急性心肌梗死,4例再次行PCI手术,与研究组比较,差异无统计学意义(χ^(2)=3.462、2.395,P>0.05)。手术后,研究组主支血管各指标与对照组比较,均差异无统计学意义(t=0.426、0.135、0.994、0.401,P>0.05);研究组分支血管中除最终对吻扩张失败率外,其余指标与对照组比较差异有统计学意义(t=6.058、3.922、4.585、4.927,P<0.05);手术后12个月,两组主支血管中各指标差异无统计学意义(t=1.999、0.280、1.020、0.088,χ^(2)=0.515,P>0.05);研究组分支血管中最小管腔直径大于对照组,直径狭窄度低于对照组,差异有统计学意义(t=6.288、23.418,P<0.05)。结论 改良后的DK Crush技术可有效提高对吻扩张的成功率,且手术后并发症少,安全性高,值得临床推广应用。

DK crush technique: modified treatment of bifurcation lesions in coronary artery

Bifurcation lesions are still technically challenging even in the era of modern stents. High incidence of restenosis both in main vessel and side branch limits the long-term prognosis although several kinds of techniques have been identified to be successful for coronary bifurcations. Reports have demonstrated the main reason for higher incidence of ostial side branch even though drugeluting stent used in side vessel lies in that there were gaps in metal coverage and drug application. Therefore,

边支支架微突T支架技术治疗冠状动脉非左主干分叉病变的效果

目的探讨观察边支支架微突T支架技术(TAP)治疗冠状动脉非左主干分叉病变的临床效果,并与双对吻挤压支架技术(DK-Crush)作对比研究。方法选取2014年7月~2017年3月南昌大学第三附属医院心内一科收治的80例冠状动脉非左主干分叉病变患者作为研究对象,随机将其分为TAP组(40例)和DK-Crush组(40例)。比较两组患者冠状动脉介入治疗(PCI)即刻的手术成功率、分叉病变情况、术中使用器械情况(支架数量,球囊数量)、手术X线曝光时间、造影剂使用量、住院期间支架内血栓发生率以及术后随访12个月的主要心血管不良事件(MACE,包括心绞痛、非致死性心肌梗塞、心源性猝死、靶血管再次血运重建)发生率。结果两组患者PCI手术即刻的成功率比较,差异无统计学意义(P>0.05)。TAP组患者的使用球囊数量、造影剂量少于DK-Crush组,差异有统计学意义(P<0.05)。TAP组患者的手术X线曝光时间短于DK-Crush组,差异有统计学意义(P<0.05)。两组患者术后随访12个月的MACE事件发生率比较,差异无统计学意义(P>0.05)。两组患者住院期间的支架内血栓发生率、6~12个月支架内再狭窄发生率比较,差异无统计学意义(P>0.05)。结论 TAP技术治疗冠状动脉非左主干分叉病变的临床近期及远期疗效与DK-Crush技术相当,但明显缩短了手术曝光时间,减少了造影剂使用量,减少了手术器械的使用数量,降低了医疗费用。

Double kissing crush technique for treatment of true coronary bifurcation lesions： two-year clinical outcomes from DKCRUSH-1 study

Standards for treating bifurcation lesions are crucial due to poor outcomes by percutaneous implantation of either bare metal stents or drug-eluting stents, even with several modified double-stent techniques including ＂T＂, ＂V＂, ＂Y＂, ＂culotte＂ and ＂simultaneous kissing stents （SKS）＂. Understanding the drawbacks in classical crush techniques, we proposed a novel double kissing （DK） crush technique being testified in our previous serial studies]＇2 The results from these randomized and pilot studies are describing a fantastic story---DK crush technique, by final kissing balloon inflation （FKBI） in 100% of lesions and high quality of kissing as assessed by both angiography and intravascular ultrasound, significantly improved the clinical outcome at a relative short-term follow-up. However, whether the advantage of the DK crush technique was sustained or not at a long-term remains unclear. The present study aimed to extend clinical follow-up and verify the differences between DK and classic crush techniques.

Hemodynamic change in wall shear stress in patients with coronary bifurcation lesions treated by double kissing crush or single-stent technique

Background Fluid dynamic mechanisms attributed to coronary bifurcation lesions remain a subject of study. The present study aimed at investigating the hemodynamic change of wall shear stress （WSS） in patients with coronary bifurcation lesions treated by double kissing （DK） crush or one-stent with final kissing balloon inflation （FKBI）. Methods Eighty-one patients with bifurcation lesions treated by stenting who had 3-D model reconstruction were studied. The bifurcation vessels were divided into main vessel （MV）, main branch （MB）, side branch （SB）, and polygon of confluence （POC）. MB and SB were classified by internal- and lateral-subsegments, respectively. Results The baseline magnitude of WSS in proximal MV, POC-MV, POC-MB, POC-SB and MB-internal segments increased significantly, compared to MB-lateral, SB-internal and SB-lateral. DK crush had the potential of uniformly reducing WSS, turbulent index and the WSS gradient. The WSS value at the POC-SB and SB in the one-stent group remained higher. The turbulent index and WSS gradient between the POC-SB minus the SB-lateral had equal predictive values for in-stent restenosis （ISR）. Conclusion Fluid dynamic results favor the use of DK crush over the one-stent technique.

双对吻挤压与经典挤压技术治疗冠状动脉分叉病变的前瞻性、随机、多中心研究

目的比较双对吻挤压（DK crush）和经典挤压技术治疗冠状动脉分叉病变的临床效果。方法311例真性分叉病变患者随机分入DK crush组（n=155）和经典挤压组（n=156），随访时间8个月。一级及二级终点分别为主要心脏不良事件（MACE，包括心肌梗死、心原性死亡和靶病变血运重建）和血管直径再狭窄及晚期丢失。结果DK crush组糖尿病患者较多。经典挤压组及DK crush组最终对吻扩张（FKBI）成功率分别为76％和100％（P〈0．001）。DK crush术式的不足包括造影剂用量大（P=0．04）、球囊数量多（P〈0．01）、手术时间长（P〈0．001），但是对吻扩张不满意率显著减少（27．6％比6．3％，P〈0．01）。临床随访率为100％，冠状动脉造影随访率为82％。经典挤压组累计再狭窄率为32．3％，而DK crush组为20．3％（P=0．01），经典挤压组分支血管再狭窄率高（24．4％比12．3％，P=0．01），而两组间主干血管再狭窄率差异无统计学意义。经典挤压组术后8个月时的累计MACE发生率为24．4％（FKBI失败组为35．9％，FKBI成功组为19．7％），显著高于DK crush组（11．4％，P=0．02）。经典挤压组血栓栓塞率为3．2％（FKBI失败组为5．1％，FKBI成功组为1．7％），而DK crush组为1．3％（P〉0．05）。经典挤压组术后8个月时无靶病变血运重建生存率为75．4％（FKBI失败组为71．2％，FKBI成功组为77．6％），而DK crush组为89．5％（P=0．002）。结论DKcrush可能是治疗冠状动脉分又病变的较佳术式。