苗立夫,黄超联,白书玲,刘云宝,曾玉杰,杨冬,王丽宁,孙晓艳,陆爱民

• 1:清华大学第一附属医院心脏中心
• 2:中日友好医院心内科
• 3:山东省胶州市中心医院

摘要(Abstract)：

目的探讨应用改良Crush技术置入双国产药物洗脱支架(DES)处理左主干Ⅳ型分叉病变的安全性和临床疗效。方法应用改良Crush技术处理患者左主干Ⅳ型分叉病变29例。即在左主干及分支中置入药物洗脱支架,主支支架部分压住分支支架2~3mm,并行对吻扩张。记录手术操作及住院相关资料,定量冠状动脉造影记录术前、术后及随访时冠状动脉资料。结果所有病例均以改良Crush术式完成国产DES置入术,并全部完成最终对吻扩张。平均操作时间36·2±9·4min,平均透视时间为18·3±3·5min。其中13例经桡动脉路径完成,16例经股动脉完成;17例(58·6%)患者为前降支开口病变,12例(44·8%)行球囊预扩张;23例置入PARTNER支架,6例置入EXCEL支架;主支支架直径为3·76±0·25mm,长度为18·19±3·40mm。本组病例无严重介入相关并发症发生。平均临床随访时间为14·2±5·2个月,无猝死、非致死性心肌梗死发生,无再狭窄及靶病变血运重建。14例(48·3%)进行冠状动脉造影随访,平均随访时间为11·5±2·7个月。定量冠状动脉造影显示基线开口狭窄率为78·4%,平均靶病变长度为13·20±4·71mm,主支支架即刻获得管腔为1·92±0·22mm,晚期管腔丢失为0·06±0·10mm,无主支支架再狭窄发生;边支晚期管腔丢失为0·21±0·12mm,无再狭窄发生;左主干晚期管腔丢失为0·09±0·12mm。结论Crush技术置入双国产DES处理左主干Ⅳ型分叉病变手术成功率高,具有很好的安全性和临床远期疗效。

关键词(KeyWords)： 支架;冠状动脉疾病;治疗结果;Crush技术

Abstract:

Keywords:

基金项目(Foundation): 清华-裕元医学研究基金(20240000556)

作者(Author): 苗立夫,黄超联,白书玲,刘云宝,曾玉杰,杨冬,王丽宁,孙晓艳,陆爱民

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