雷帕霉素洗脱支架对吻术与单支架术对冠状动脉分叉病变疗效的影响  

Comparison of long-term efficacy of simultaneous kissing sirolimus-eluting stent technique versus provisional side-branch stenting in true coronary bifurcations

作　　者：庄少伟[1] 王天松[2] 李新明[1] 姚震[2] 冯旭霞[2] 胡大一[3] 

机构地区：[1]同济大学附属东方医院心内科,上海200120 [2]海南省三亚市人民医院心内科,海南三亚572000 [3]北京大学人民医院心脏中心,北京100044

出　　处：《同济大学学报（医学版）》2010年第5期67-70,74,共5页Journal of Tongji University(Medical Science)

摘　　要：目的比较雷帕霉素洗脱支架对吻技术与单支架技术对真性分叉病变的近、远期疗效的影响。方法 200名分叉病变患者,随机分为对吻支架术和单支架术两组。随访1年,观察两组节段内再狭窄率、死亡率、非致死性心肌梗死率、靶病变再次血运重建率和支架内血栓形成率。结果术后1年,单支架组与对吻支架组相比,再狭窄率、死亡率、心肌梗死发生率、靶病变再次血运重建率、支架内血栓发生率及严重心血管不良事件发生率差异均无统计学意义(P>0.05);分支预扩张后,出现夹层的患者分析提示单支架与对吻支架组节段内再狭窄率、靶病变再次血运重建率及严重心血管不良事件发生率差异有统计学意义(P<0.05),而支架内血栓率、死亡率及心肌梗死率差异无统计学意义(P>0.05)。结论对于直径较大的分叉病变患者,对吻支架技术的近、远期疗效与单支架术相近。预扩张后分支出现夹层应采用对吻支架术,没有夹层则应采用单支架植入。Obejective To evaluate the long-term efficacy of simultaneous kissing sirolimus-eluting（SKS） stent technique versus provisional side-branch stenting（PSS） in true coronary bifurcations.Methods One hundred patients with a coronary bifurcation lesion were randomized selected to be treated with simultaneous kissing stenting with sirolimus-eluting stents（SES） in both branches and 100 patients to be treated with provisional side-branch stenting with SES in the main branch followed by provisional SES placement in the side branch only for inadequate results.The patients were followed up for one year for monitoring in-segment restenosis rate,the occurrence of major adverse cardiac events（death,myocardial infarction,target-lesion revascularization） and stent thrombosis.Results There were no significant differences in clinical features including in-segment restenosis,death,myocardial infarction,target-lesion revascularization,stent thrombosis and major adverse cardiac events between PSS group and SKS group during the 12 months follow-up period（P0.05）.In the patients with dissection formation during predilation of side-branches,there were no differences on death,myocardial infarction and stent thrombosis between treatment with PSS and with SKS（P0.05）,However,the occurrences of in-segment restenosis,target-lesion revascularization and major adverse cardiac events in these patients with dissection formation were higher if treated with PSS（P0.05）.Conclusion In large coronary bifurcations,SKS and PSS had similar in-hospital and long-term efficacy.If there were dissection formation in the side-branches after pre-dilation,the SKS technique should be selected.Otherwise,the PSS technique should be considered.

关 键 词：经皮冠脉腔内成形术 药物洗脱支架 分叉病变 

分 类 号：R543.3[医药卫生—心血管疾病]