郑绪伟,柳景华

• 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

摘要(Abstract)：

<正>冠状动脉分叉区域是动脉粥样硬化容易累及的部位,分叉病变约占经皮冠状动脉介入治疗(PCI)的15%~20%。尽管如今处在药物洗脱支架时代,但对于冠状动脉分叉病变的治疗仍然是一个挑战。心血管介入医师通常会根据分叉病变的解剖学特征(斑块分布、分叉角度、主支/边支血管直径)选择相应的PCI处理策略。与其他病变相比,冠状动脉分叉病变的PCI治疗具有更高的并发症和再狭窄发生率[1]。

关键词(KeyWords)： 冠状动脉分叉病变;血液流变学

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 郑绪伟,柳景华

参考文献(References)：

• [1]Moore JJ,Timmins LH,Ladisa JJ.Coronary artery bifurcation biomechanics and implications for interventional strategies.Catheter Cardiovasc Interv,2010,76:836-843.
• [2]Caro CG,Fitz-Gerald JM,Schroter RC.Arterial wall shear and distribution of early atheroma in man.Nature,1969,223:1159-1160.
• [3]Cheng C,Tempel D,van Haperen R,et al.Atherosclerotic lesion size and vulnerability are determined by patterns of fluid shear stress.Circulation,2006,113:2744-2753.
• [4]Wentzel JJ,Chatzizisis YS,Gijsen FJ,et al.Endothelial shear stress in the evolution of coronary atherosclerotic plaque and vascular remodelling:current understanding and remaining questions.Cardiovasc Res,2012,96:234-243.
• [5]Koskinas KC,Chatzizisis YS,Antoniadis AP,et al.Role of endothelial shear stress in stent restenosis and thrombosis:pathophysiologic mechanisms and implications for clinical translation.J Am Coll Cardiol,2012,59:1337-1349.
• [6]Cecchi E,Giglioli C,Valente S,et al.Role of hemodynamic shear stress in cardiovascular disease.Atherosclerosis,2011,214:249-256.
• [7]Murasato Y,Hikichi Y,Nakamura S,et al.Recent perspective on coronary bifurcation intervention:statement of the"Bifurcation Club in KOKURA".J Interv Cardiol,2010,23:295-304.
• [8]Chatzizisis YS,Giannoglou GD.Shear stress and infl ammation:are we getting closer to the prediction of vulnerable plaque.Expert Rev Cardiovasc Ther,2010,8:1351-1353.
• [9]Huo Y,Finet G,Lefevre T,et al.Which diameter and angle rule provides optimal flow patterns in a coronary bifurcation.J Biomech,2012,45:1273-1279.
• [10]Gijsen FJ,Wentzel JJ,Thury A,et al.A new imaging technique to study 3-D plaque and shear stress distribution in human coronary artery bifurcations in vivo.J Biomech,2007,40:2349-2357.
• [11]Soulis JV,Farmakis TM,Giannoglou GD,et al.Wall shear stress in normal left coronary artery tree.J Biomech,2006,39:742-749.
• [12]Soulis JV,Giannoglou GD,Chatzizisis YS,et al.Spatial and phasic oscillation of non-Newtonian wall shear stress in human left coronary artery bifurcation:an insight to atherogenesis.Coron Artery Dis,2006,17:351-358.
• [13]Toggweiler S,Urbanek N,Schoenenberger AW,et al.Analysis of coronary bifurcations by intravascular ultrasound and virtual histology.Atherosclerosis,2010,212:524-527.
• [14]Giannoglou GD,Antoniadis AP,Koskinas KC,et al.Flow and atherosclerosis in coronary bifurcations.Euro Intervention,2010,6Suppl J:J16-J23.
• [15]van der Giessen AG,Wentzel JJ,Meijboom WB,et al.Plaque and shear stress distribution in human coronary bifurcations:a multislice computed tomography study.Euro Intervention,2009,4:654-661.
• [16]Moore JJ,Timmins LH,Ladisa JJ.Coronary artery bifurcation biomechanics and implications for interventional strategies.Catheter Cardiovasc Interv,2010,76:836-843.
• [17]Chen HY,Moussa ID,Davidson C,et al.Impact of main branch stenting on endothelial shear stress:role of side branch diameter,angle and lesion.J R Soc Interface,2012,9:1187-1193.
• [18]Ding Z,Biggs T,Seed WA,et al.Influence of the geometry of the left main coronary artery bifurcation on the distribution of sudanophilia in the daughter vessels.Arterioscler Thromb Vasc Biol,1997,17:1356-1360.
• [19]Dzavik V,Kharbanda R,Ivanov J,et al.Predictors of long-term outcome after crush stenting of coronary bifurcation lesions:importance of the bifurcation angle.Am Heart J,2006,152:762-769.
• [20]Adriaenssens T,Byrne RA,Dibra A,et al.Culotte stenting technique in coronary bifurcation disease:angiographic follow-up using dedicated quantitative coronary angiographic analysis and 12-month clinical outcomes.Eur Heart J,2008,29:2868-2876.
• [21]Gil RJ,Vassilev D,Formuszewicz R,et al.The carina angle-new geometrical parameter associated with periprocedural side branch compromise and the long-term results in coronary bifurcation lesions with main vessel stenting only.J Interv Cardiol,2009,22:E1-E10.
• [22]Ladisa JJ,Olson LE,Guler I,et al.Circumferential vascular deformation after stent implantation alters wall shear stress evaluated with time-dependent 3D computational fluid dynamics models.J Appl Physiol(1985),2005,98:947-957.
• [23]Vassilev D,Gil R.Clinical verifi cation of a theory for predicting side branch stenosis after main vessel stenting in coronary bifurcation lesions.J Interv Cardiol,2008,21:493-503.
• [24]Vassilev D,Gil RJ.Relative dependence of diameters of branches in coronary bifurcations after stent implantation in main vesselimportance of carina position.Kardiol Pol,2008,66:371-378,379.
• [25]Williams AR,Koo BK,Gundert TJ,et al.Local hemodynamic changes caused by main branch stent implantation and subsequent virtual side branch balloon angioplasty in a representative coronary bifurcation.J Appl Physiol(1985),2010,109:532-540.
• [26]Chen SL,Kan J,Zhang JJ,et al.Hemodynamic change in wall shear stress in patients with coronary bifurcation lesions treated by double kissing crush or single-stent technique.Chin Med J(Engl),2012,125:1720-1726.
• [27]Hu ZY,Chen SL,Zhang JJ,et al.Distribution and magnitude of shear stress after coronary bifurcation lesions stenting with the classical crush technique:a new predictor for in-stent restenosis.J Interv Cardiol,2010,23:330-340.
• [28]Zhang JJ,Chen SL,Hu ZY,et al.Contradictory shear stress distribution prevents restenosis after provisional stenting for bifurcation lesions.J Interv Cardiol,2010,23:319-329.
• [29]Katritsis DG,Theodorakakos A,Pantos I,et al.Flow patterns at stented coronary bifurcations:computational fluid dynamics analysis.Circ Cardiovasc Interv,2012,5:530-539.