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目的检验作者改良的DK Crush技术能否确保最终对吻扩张的成功。方法本研究属于连续、非随机和开放式研究,共入选了88例真性分叉病变(分支血管直径>2.0mm)的患者。其中2004年10月至2005年1月间入选的44例患者接受经典Crush技术治疗,2005年1月至2005年6月间入选的44例患者接受DK Crush技术治疗。比较两组患者术前、术中和术后30d内的诸项参数。结果DK Crush组与经典Crush组比较,患者分支血管病变长度长(13.5±3.4mm比7.8±3.1mm,P<0.05)、经皮冠状动脉介入术需时短(44±12min比68±17min,P<0.05)、最终对吻扩张成功率高(100%比70%,P<0.01)、使用球囊数量少(1.6±0.4个比2.7±0.7个,P<0.05)及造影剂使用量小(102±38mL比176±46mL,P<0.05)。DKCrush组与经典Crush组患者的主干与分支血管之间的夹角[(57±18)°比(47±15)°],主干血管病变长度(24.3±8.6mm比21.1±7.3mm)差异均无统计学意义(P均>0.05)。经典Crush组有两例(4.3%)最终对吻失败的患者出现亚急性血栓栓塞。DK Crush组术后即刻分支血管开口部位最小血管直径显著大于经典Crush组(3.01±0.13mm比2.74±0.12mm,P<0.01),而残余狭窄却显著小于后者(7.3%±8.6%比17.4%±11.2%,P<0.05)。经典Crush组有5例患者术后即刻分支血管开口残余狭窄>30%(对吻失败)。结论经典Crush技术存在的技术缺陷是导致预后不良的主要原因。改良的DK Crush技术能显著提高对吻扩张的成功率,进一步的随机研究可以明确后者的有效性。
Aim To test whether the authors’ improved DK Crush technique can ultimately ensure successful kiss expansion. Methods This study was a continuous, nonrandomized, open-ended study of 88 patients with true bifurcation lesions (branch vessel diameter> 2.0 mm). Among them, 44 patients selected from October 2004 to January 2005 were treated with classical Crush technique and 44 patients selected from January 2005 to June 2005 were treated with DK Crush technique. The two groups of patients before surgery, intraoperative and postoperative 30d parameters. Results Compared with the classic Crush group, the length of branch vessel lesions was longer in DK Crush group (13.5 ± 3.4 mm vs 7.8 ± 3.1 mm, P <0.05) and shorter in percutaneous coronary intervention (44 ± 12 mm vs 68 ± 17 min, (100% vs 70%, P <0.01). The number of balloons used was less (1.6 ± 0.4 vs. 2.7 ± 0.7, P <0.05) and the use of contrast media was less (102 ± 38 mL vs 176 ± 46 mL, P <0.05). The angle between the trunk and branch vessels in the DKCrush group and the classic Crush group was (57 ± 18) ° versus (47 ± 15) °, and the length of the primary vascular lesion was (24.3 ± 8.6 mm vs. 21.1 ± 7.3 mm) No statistical significance (P> 0.05). Two patients (4.3%) in the classic Crush group developed subacute thromboembolism in the event of unsuccessful kissing. The minimal vessel diameter of branch opening in DK Crush group was significantly larger than that of the classic Crush group (3.01 ± 0.13mm vs. 2.74 ± 0.12mm, P <0.01), while the residual stenosis was significantly smaller than that of the latter (7.3% ± 8.6% vs. 17.4 % ± 11.2%, P <0.05). In the classic Crush group, 5 patients had a residual stenosis of> 30% immediately after the opening of the vessel opening (failure of kissing). Conclusion The technical defects of classical Crush technique are the main reasons leading to poor prognosis. Improved DK Crush technology can significantly improve the success rate of kiss expansion, further randomized studies can confirm the effectiveness of the latter.