DK Crush技术治疗真性冠状动脉分叉病变:与经典Crush技术的对比  

DK Crush technique for treatment of true coronary bifurcation lesions: comparison with classical Crush technique

作　　者：陈绍良[1] 方唯一[2] 魏盟[3] 何奔[4] 张瑞岩[5] 陈韵岱[6] 张俊杰[1] 叶飞[1] 朱中生[1] 林松[1] 单守杰[1] 杨松[7] 钱均[8] Damras Michael Lee Tan Huaycheem Tejas Patel 

机构地区：[1]南京医科大学附属南京市第一医院,南京市心血管病医院心内科,南京市210006 [2]上海胸科医院心内科 [3]上海市第六人民医院心内科 [4]上海仁济医院心内科 [5]上海瑞金医院心内科 [6]北京安贞医院心内科 [7]江苏省宜兴市人民医院心内科 [8]安徽省马鞍山市中心医院心内科 [9]泰国曼谷医科大学附属医院心内科 [10]香港伊丽莎白医院心内科 [11]新加坡国立大学医院心内科 [12]印度Sterin集团医院心内科

出　　处：《中国介入心脏病学杂志》2007年第2期61-66,共6页Chinese Journal of Interventional Cardiology

摘　　要：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。Objective To evaluate the effect of modified DK Crush technique with double kissing and double Crush on the procedural success rate for bifurcation coronary lesion. Methods and Results This is a consecutive, non-randomized, open-label study. Eighty-eight consecutive patients with single true coronary bifurcation lesion according to Lefevre Classification and side branch diameter 〉 2. 0 mm were enrolled into the study. The first 44 patients （from October 2004 to January 2005 ） and the later 44 patients （from February 2005 to June 2005 ） were assigned to receive classical Crush and DK Crush technique, respectivelly. Data before and within 30 days after the operation were analyzed. Patients in the DK Crush group, compared with those in the classical Crush group, were characterized by longer lesion length in side branch （13.5 ±3.4 mm vs 7.8 ±3. 1 ram, P 〈0.05） , shorter procedural time （44±12 min vs 68 ± 17 min, P 〈 0. 05 ）, higher success rate of FKBI （ 100% vs 70%, P 〈 0. 01 ） and lower volume of contrast consummed （ 102 ± 38 mm vs 176 ± 46 mm, P 〈 0.05 ）. There was a tendency that patients in the DK Crush group had larger bifurication angle between the main vessel and side branch [ （57 ± 18 ）°vs （47 ± 15 ） ° ] and longer lesion length in the main vessel （24. 3 ± 8.6 mm vs 21.1± 7.3 mm） although without significant differences （P 〉 0. 05, respectivelly）. Sub-acute stent thrombosis were detected in 2 patients with failure of FKBI in the classical Crush group （4. 3% ）. Patients in the classical Crush group, compared with those in the DK Crush group, were characterized by smaller minimum lumen diameter （MLD） at side branch ostium （2.74 ±0. 12 mm vs 3.01 ±0. 13 mm,P 〈0. 01 ） and higher degree of residual stenosis at ostial side branch （ 17.4 ± 11.2% vs 7. 3% ± 8.6%, P 〈 0. 05 ）. Notably, there were five patients whose residual diameter restenosis at ostial side branch was 〉 30%, which was defined as failure of the operation. Concl

关 键 词：冠状动脉疾病 血管成形术 经腔 经皮冠状动脉 支架 

分 类 号：R543.3[医药卫生—心血管疾病]