戚晨良,尤威,叶飞,吴志明,贾海波,陈绍良,张俊杰,刘玲玲,林玲,徐海梅

• 1:常州市中医医院心内科
• 2:南京医科大学附属南京医院心内科

摘要(Abstract)：

目的回顾性对比研究应用直接精确定位支架技术、跨越支架技术及Szabo技术,治疗孤立性前降支(LAD)或回旋支(LCX)开口病变的近期有效性和安全性。方法回顾性分析2012年1月至2015年11月共计89例孤立性LAD或LCX开口病变(左主干末端Medina分型为0,1,0或0,0,1)行介入治疗的患者,分为直接精确定位支架组(D组)20例、使用跨越支架技术组(C组)44例以及使用Szabo技术组(S组)25例,比较三组支架置入成功率、平均手术时间及对比剂肾病发生率、住院期间及术后1年的临床主要不良心血管事件[MACE,包括非致死性心肌梗死、缺血驱动的靶血管血运重建(TVR)和死亡]随访结果。结果三组患者介入治疗均使用6 F指引导管,但S组EBU指引导管使用率高于D组(56.0%比10.0%,P=0.001)和C组(56.0%比11.4%,P<0.001),S组J L指引导管使用率低于D组(44.0%比90.0%,P=0.001)和C组(44.0%比88.6%,P<0.001),差异均有统计学意义。S组手术成功率明显低于D组(72.0%比100.0%,P=0.010)和C组(72.0%比100.0%,P<0.001),主要表现在S组需更改介入治疗技术方案发生率要高于D组(24.0%比0.0,P=0.019)和C组(24.0%比0.0,P=0.001),且S组支架脱载发生率要高于D组(12.0%比0.0,P=0.010)和C组(12.0%比0.0,P=0.019)。但是术中需使用球囊对吻扩张发生率C组要明显高于S组(22.7%比0.0,P=0.010)。三组患者住院期间累计MACE发生率比较,差异无统计学意义(P=1.000)。但术后1年随访累计MACE发生率D组明显高于C组(25.0%比2.3%,P=0.002)和S组(25.0%比0.0,P=0.023),主要表现在术后1年随访TVR发生率D组要明显高于C组(20.0%比2.3%,P=0.008)和S组(20.0%比0.0,P=0.045),C组术后1年随访对侧分支开口狭窄>50%发生率明显高于S组(22.7%比0.0,P=0.042)。结论对于孤立性LAD或LCX开口病变不推荐常规使用直接精确定位支架技术,使用Szabo技术和跨越支架技术处理患者近期预后良好,但需注意的是使用Szaob技术治疗手术失败率较高,而使用跨越支架技术近期分支开口狭窄发生率较高。

关键词(KeyWords)： 血管成形术;经皮冠状动脉介入治疗;开口病变;跨越支架技术;Szabo技术

Abstract:

Keywords:

基金项目(Foundation): 南京市医学科技发展资金(YKK15103);; 南京市科技发展计划项目(2015sc511008)

作者(Author): 戚晨良,尤威,叶飞,吴志明,贾海波,陈绍良,张俊杰,刘玲玲,林玲,徐海梅

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