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目的探讨应用双药物洗脱支架(DES)治疗分叉病变的临床疗效。方法选择分支开口有严重狭窄且分支口径≥2.50mm的分叉病变患者为本研究的入选对象。2003年10月至2005年6月共入选应用双DES治疗分叉病变的患者112例,113处病变。分叉病变的类型为前降支/对角支62例(54.9%),左冠状动脉主干分叉病变32例(28.3%),回旋支/钝缘支18例(15.9%),右冠状动脉远端分叉病变1例。113处分叉病变中采用Crush技术64处,“T”型支架置入27处;改良“Y”型支架置入11处;对吻支架置入5处;“V”型支架置入和Culotte技术置入各3处。结果入选112例患者113处分叉病变中(226处病变)使用Cypher或CypherselectDES91个,TAXUSDES74个,FirebirdDES67个。64处分叉病变采用Crush技术置入双支架后60处(93.7%)完成了最后的对吻球囊扩张技术。手术成功率为100%。住院期间1例发生亚急性血栓致急性心肌梗死(AMI),再次介入治疗成功。住院期间心脏事件发生率(MACE,包括死亡、AMI、再次血管重建)为0.89%(1/112)。112例均完成了9个月的临床随访,无死亡发生,1例发生AMI由晚期血栓形成所致。48例完成了9个月的冠状动脉造影随访(42.9%),8例发生了支架内再狭窄,其中1例进行了冠状动脉旁路移植术,5例再次行介入治疗,总再狭窄发生率为16.7%(8/48)。随访期间MACE发生率为8.04%(9/112)。结论本研究结果显示对于分支口径≥2.5mm且口部有严重狭窄性病变的分叉病变,采用双DES治疗是安全的,近、远期临床疗效是满意的。与CypherDES相比较,TAXUSDES的再狭窄发生率有增加的趋势。
Objective To investigate the clinical efficacy of dual drug-eluting stent (DES) in the treatment of bifurcation lesions. Methods Patients with severe bifurcation of branches and bifurcation lesions with branch diameter ≥2.50 mm were selected as the study subjects. From October 2003 to June 2005, 112 patients with bifurcation lesions were selected and 113 lesions were included. The types of bifurcation were 62 cases (54.9%) of anterior descending branch / diagonal branch, 32 cases (28.3%) of the left main coronary artery bifurcation lesion, 18 cases (15.9%) of the circumflex branch / obturator branch and the right coronary artery Distal bifurcation lesions in 1 case. Thirty-seven crush lesions were treated with crush technique, 27 with “T” stents, 11 with “Y” stents, 5 with kiss stents, and “V” stents with Culotte Technology into the three. Results Of the 112 bifurcated lesions in 112 patients (91 of 226 lesions), 91 were Cypher or Cypherselect DES, 74 were TAXUSDES and 67 were Firebird DES. Sixty-six (93.7%) bifurcation lesions were completed using the Crush technique in the double bifurcations at 64, completing the last kissing balloon dilatation technique. Surgical success rate was 100%. One patient had subacute thrombotic acute myocardial infarction (AMI) during hospitalization, and the intervention was successful again. The incidence of cardiac events (MACE, including death, AMI, revascularization) during hospitalization was 0.89% (1/112). All 112 patients completed 9 months of clinical follow-up without death, and 1 patient developed AMI due to advanced thrombosis. Forty-eight patients underwent 9-month follow-up of coronary angiography (42.9%) and in-stent restenosis in 8 patients. One patient underwent coronary artery bypass grafting and another 5 received interventional intervention. The overall incidence of restenosis 16.7% (8/48). The incidence of MACE during follow-up was 8.04% (9/112). Conclusion The results of this study show that for patients with bifurcation lesions with branch diameter ≥2.5 mm and severe stenosis at the mouth, the use of dual DES is safe and the short-term and long-term clinical outcomes are satisfactory. Compared with CypherDES, TAXUSDES tend to increase the incidence of restenosis.