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目的:评价T支架技术治疗分叉病变的临床效果。方法:回顾性分析从2004年4月到2006年1月我院对分叉病变连续行T支架技术47例患者临床情况。结果:患者基线特点:年龄(59.2±10.8)岁;性别:男性89.4%;既往心肌梗死27.7%;既往经皮冠状动脉介入治疗(PCI)19.1%;糖尿病23.4%;左心室射血分数0.48±0.34。病变基线特点:病变位置:左主干分叉42.6%、前降支和对角支53.2%、回旋支和钝缘支4.3%;主支参照血管直径(3.43±0.51)mm;边支参照血管直径(2.85±0.19)mm;主支病变长度(17.6±10.6)mm;边支病变长度(13.2±7.6)mm。经股动脉入径59.6%;置入药物洗脱支架56.4%;主支支架释放压力(14.5±2.8)atm(1 atm=101.325 kPa);边支支架释放压力(12.3±2.5)atm;对吻球囊技术(kissing balloon) 89.4%。支架置入成功率100%。主要心脏不良事件(MACE)6例(13%);死亡1例(2.1%),因支架内亚急性血栓形成;急性心肌梗死2例(4.3%),造影证实为支架内亚急性血栓形成,行急诊PCI治疗;靶病变再次血管成形术5例(10.6%),其中2例因支架亚急性血栓、2例因再狭窄行再介入治疗,1例因再狭窄行冠状动脉旁路移植术。6个月临床随访91.5%,造影随访29.8%,再狭窄率21.4%。结论:T支架技术治疗分叉病变操作成功率很高,但具有一定风险。
Objective: To evaluate the clinical effect of T-stent technique in the treatment of bifurcation lesions. Methods: From April 2004 to January 2006, 47 cases of bifurcation patients undergoing continuous T-stent technique were retrospectively analyzed. RESULTS: The baseline characteristics of the patients were 59.2 ± 10.8 years of age, 89.4% of men, 27.7% of previous myocardial infarctions, 19.1% of previous PCI, 23.4% of diabetic patients, and 0.48 ± of left ventricular ejection fraction 0.34. Lesion baseline characteristics: lesion location: the left main bifurcation 42.6%, anterior descending branch and diagonal branch 53.2%, the bronchus and blunt margins 4.3%; main branch reference vascular diameter (3.43 ± 0.51) mm; (2.85 ± 0.19) mm; the length of the main branch was (17.6 ± 10.6) mm; the length of the branch was (13.2 ± 7.6) mm. 59.6% of the diameter of the femoral artery was implanted; 56.4% of the patients were placed in the drug-eluting stent; the release pressure of the main stent was 14.5 ± 2.8 atm (1 atm = 101.325 kPa); the release pressure of the stent-graft was (12.3 ± 2.5) Kissing balloon 89.4%. Stent implantation success rate of 100%. Six patients (13%) had major adverse cardiac events (MACE), one died (2.1%) due to subacute thrombosis within the stent and two (4.3%) patients with acute myocardial infarction. Angiography confirmed subacute thrombosis within the stent. Five patients (10.6%) underwent re-angioplasty with target lesion. Two patients received sub-acute stent thrombosis, two received restenosis, and one received coronary artery bypass grafting due to restenosis. Six months clinical follow-up 91.5%, angiography follow-up 29.8%, restenosis rate 21.4%. Conclusion: The success rate of T-stent technique in treating bifurcation lesions is high, but it has some risks.