不同双支架策略对冠状动脉分叉病变预后和分叉局部流体力学的影响  

The effect of different double stent strategies on the clinical prognosis of coronary artery bifurcation lesions and the local hydrodynamics of the bifurcation

作　　者：郑绪伟[1] 陈魁[1] 张斌[1] 张亚豪 申泱泱[1] 柳景华[2] ZHENG Xuwei;CHEN Kui;ZHANG Bin;ZHANG Yahao;SHEN Yangyang;LIU Jinghua(Department of Cardiology,The First Affiliated Hospital of Zhengzhou University,Zhengzhou 450002,China)

机构地区：[1]郑州大学第一附属医院心血管内科,450002 [2]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冠心病中心

出　　处：《心肺血管病杂志》2022年第8期845-850,共6页Journal of Cardiovascular and Pulmonary Diseases

基　　金：河南省高等学校重点科研项目(20A320025)。

摘　　要：目的:评价Crush与Culotte策略在真性分叉病变中的安全性和有效性,并从流体力学的角度评价采取两种术式后分叉局部血流动力学的不同改变。方法:连续入选300例真性分叉病变患者并随机分配至Crush治疗组或Culotte治疗组,进行1年的临床和造影随访。主要终点为主要心血管不良事件(包括心源性猝死、心肌梗死、支架内血栓及靶血管再次血运重建等)的发生率,次要终点为支架内再狭窄的发生率。同时,应用计算流体力学的方法分析两组分叉局部的血流动力学变化。结果:术后1年随访结果显示,Crush治疗组和Culotte治疗组主要心血管不良事件发生率分别为6.7%和5.3%,两组间差异无统计学意义(P>0.05);Crush治疗组的支架内再狭窄的发生率高于Culotte治疗组患者(P<0.05),分别为12.7%和6.0%。Crush治疗组中分叉区域时间平均壁面剪切力的面积分值显著低于Culotte治疗组[(5.01±0.95)×10^(-4)N vs.(6.08±1.16)×10^(-4)N,P<0.01]。结论:Crush技术及Culotte技术在处理复杂冠状动脉分叉病变中均安全有效。相较于Crush技术,应用Culotte技术治疗的分叉病变患者可能具有更低的支架内再狭窄发生率以及更佳的分叉局部流体力学效果。Objective:To evaluate the safety and effectiveness of the Crush and Culotte strategies in true bifurcation lesions,and their effect on local hemodynamics of the bifurcation.Methods:A total of 300 patients with coronary bifurcation lesions were randomly assigned to the Crush group(n=150)and Culotte group(n=150).They are performed 1-year clinical and angiographic follow-up.The primary endpoint was the occurrence of major adverse cardiac events at 1-year,including cardiac death,myocardial infarction,stent thrombosis,and target vessel revascularization.in-stent restenosis at 1-year was the secondary endpoint.At the same time,the local hemodynamic changes of bifurcation lesions are analyzed from the perspective of fluid mechanics.Results:There were no significant differences in major adverse cardiac event rates between the two groups at 1-year follow-up;Crush 6.7%,culotte 5.3%(P>0.05).The incidence of in-stent restenosis in the Crush group is higher than in the Culotte group(P<0.05),the incidence of in-stent restenosis was 12.7%vs.6.0%in the Crush and the Culotte groups,respectively.At 1-year follow-up,the surface integrals of time-averaged wall shear stress at bifurcation sites in the Crush group were significantly lower than the Culotte group[(6.08±1.16)×10^(-4)N vs.(5.01±0.95)×10^(-4)N,respectively;P<0.01].Conclusions:Both the Crush and the Culotte bifurcation stenting technique showed satisfying clinical and angiographic results at 1-year follow-up.Bifurcation lesions treated with the Culotte technique tended to have lower restenosis rates and more favorable flow patterns.

关 键 词：分叉病变 冠状动脉介入治疗 支架策略 血流动力学 

分 类 号：R54[医药卫生—心血管疾病]