优化的Culotte术式在冠状动脉真性分叉病变中的应用  

Optimized culotte technique in true coronary bifurcation lesions

作　　者：苑飞[1] 宋现涛[1] 柳弘[1] 葛长江[1] 田锐[1] 陈欣[1] 吕树铮[1] 

机构地区：[1]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所心内科1病房,100029

出　　处：《心肺血管病杂志》2016年第7期510-513,共4页Journal of Cardiovascular and Pulmonary Diseases

基　　金：国家科技支撑计划(2011BAI11B05)

摘　　要：目的：探讨在Culotte技术中优化再导丝化操作（Re-wire）,对真性冠状动脉分叉病变中应用的安全性和有效性。方法：研究入选冠状动脉造影证实的Medina分型,1,1,1型分叉病变患者146例,其中78例接受传统Culotte术式治疗（传统组）,68例接受优化Culotte术式（优化组）。随访12个月,并于术后9-12个月复查冠状动脉造影,观察入选患者的临床基本特征、手术操作特征、冠状动脉脉造影随访及12个月的临床随访结果。结果：两组手术成功率和最终对吻球囊扩张率均为100%,在病变处理时间和造影剂用量上两组结果相似,差异无统计学意义（P〉0.05）。共有109例患者完成冠状动脉造影随访。与传统组相比,优化组分支支架内晚期管腔丢失（LLL）明显降低[（0.32±0.30）vs.（0.20±0.23）mm,P=0.01],分支开口LLL也明显降低[（0.34±0.38）vs.（0.22±0.31）mm,P=0.02],分支支架内再狭窄率有降低的趋势（10.9%vs.1.8%）,但差异无统计学意义（P=0.11）。两组患者随访期间的主要不良心脏事件和支架内血栓的发生率分别比较,差异均无统计学意义（P〉0.05）。结论：优化Re-wire操作明显降低了Culotte技术在分叉病变分支支架内和分支开口的晚期管腔丢失,取得了良好的长期临床疗效,手术成率高,同时并未明显延长病变处理时间。Objective： To observe the effectiveness and safety of optimized re-wire operation with Culotte technique in true coronary bifurcation lesions. Methods ： 146 patients with Medina 1,1,1 de novo coro- nary bifurcation lesions were enrolled. 68 patients treated with optimized Culotte technique （optimized group） and other78 patients with traditional Culotte technique （traditional group）. The basic clinical and angiographic characteristics, immediate results of percutaneous coronary intervention （PCI）, angiographic follow-up results, and major adverse cardiac event （MACE） defined as target vessel revascularization （TVR）, non-fatal myocardial infarction （NFMI）, and cardiac death （CD） were analyzed between two groups during 12-month follow-up. Results： All stent implanted procedures and final kissing balloon inflation were successfully completed in both groups. The procedure time and contrast dosage were similar in both groups （P 〉 0.05）. 109 patients completed angiographic follow-up. Compared with traditional group, in-stent late lumen loss （LLL） of side branch was significant lower in optimized group [ （0. 32 ±0. 30） vs. （0. 20 ±0. 23 ） mm, P = 0.01 ], and with LLL of side branch ostium [ （0. 34± 0. 38） vs. （0. 22± 0. 31 ） mm, P = 0.02 ]. The in-stent restenosis rate of side branch was lower in optimized group, but with no significant difference, 10.9% vs. 1.8% （P =0. 11 ）. Major adverse cardiovascular event （MACE） occurred in 11.5% vs. 5.9%, TVR in 11.5% vs. 5.9%, NFMI in 2. 6% vs.0% , CD both 0% , and stent thrombosis in 1.3 vs. 0% ; and events were comparable between the traditional group and optimzed group at 12-month follow-up （all P 〉 0. 05 ）. Conclusion： Optimized re-wire operation with culotte technique significantly reduced in-stent LLL of side branch and side branch ostium with good clinical outcomes and high procedure success rate, and without prolonged procedure time.

关 键 词：冠状动脉疾病 经皮冠状动脉介入术 冠状动脉分叉病变 Culotte支架术 

分 类 号：R54[医药卫生—心血管疾病]