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目的介绍一种新型改良的裙裤(Culotte)技术处理真性冠状动脉分叉病变的初步临床经验。方法纳入2014年6月至2015年3月于福建医科大学附属协和医院采用单环Culotte支架术处理的15例真性冠状动脉分叉病变患者。记录患者手术时间、X线透视时间、对比剂用量,定量分析患者病变长度、术前和术后即刻最小管腔直径、参考血管直径及直径狭窄百分比,观察院内主要不良心血管事件(MACE)发生率。结果手术成功率为100%,未见手术并发症和院内MACE发生。手术时间为(34.3±9.6)min,X线透视时间为(18.1±3.8)min,对比剂用量为(112.0±24.5)ml。术前主支病变长度[(26.5±11.2)mm比(12.2±4.8)mm,P=0.001]、参考血管直径[(3.44±0.60)mm比(2.77±0.43)mm,P<0.001]和直径狭窄百分比[(80.8±11.8)%比(70.3±12.6)%,P=0.002]显著大于边支血管,而最小管腔直径显著小于边支血管[(0.64±0.36)mm比(0.82±0.35)mm,P=0.044];术后主支参考血管直径[(3.54±0.67)mm比(2.90±0.49)mm,P<0.001]和最小管腔直径[(3.18±0.61)mm比(2.61±0.46)mm,P<0.001]均显著大于边支血管,而直径狭窄百分比差异无统计学意义[(10.0±2.5)%比(10.2±5.3)%,P=0.932]。结论单环Culotte支架术安全易行,或许优于传统的Culotte支架术。
Objective To introduce a new type of modified Culotte technique for the treatment of true coronary bifurcation lesions in primary clinical experience. Methods From June 2014 to March 2015, 15 patients with true coronary artery bifurcation underwent single-ring Culotte stenting in Union Hospital, Fujian Medical University. The patients’ operation time, X-ray time, contrast medium dosage, quantitative analysis of patient’s lesion length, minimal lumen diameter before operation and immediately after operation, reference vascular diameter and diameter stenosis percentage were recorded to observe the occurrence of major adverse cardiovascular events (MACE) in hospital rate. Results The successful rate of operation was 100%. No operative complications and hospital MACE occurred. The operation time was (34.3 ± 9.6) min, the radiography time was (18.1 ± 3.8) min and the contrast agent dosage was (112.0 ± 24.5) ml. The length of the main branch of preoperative lesion was (26.5 ± 11.2) mm (12.2 ± 4.8) mm, P = 0.001], and the reference vessel diameter [(3.44 ± 0.60) mm vs (2.77 ± 0.43) mm, P <0.001] The percentage of stenosis was (80.8 ± 11.8)% (70.3 ± 12.6)%, P = 0.002], but the diameter of the smallest lumen was significantly smaller than that of the marginal branch (0.64 ± 0.36) mm (0.82 ± 0.35) (P <0.001) and the diameter of the smallest lumen (3.18 ± 0.61) mm (2.61 ± 0.46 mm, P <0.001) ) mm, P <0.001] were significantly higher than those of the marginal vessels, while there was no significant difference in the percentage of diameter stenosis (10.0 ± 2.5% vs 10.2 ± 5.3%, P = 0.932). Conclusions Single-loop Culotte stenting is safe and may be superior to traditional Culotte stenting.