冠状动脉分叉病变介入治疗的边支保护和补救技术策略
宋林林,金哲
摘要(Abstract):
<正>冠状动脉分叉病变长久以来一直是经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)的难点之一,主要在于手术操作复杂,术中并发症及围术期心肌梗死发生率高,远期靶病变血运重建(target lesion revascularizition,TLR)、支架内再狭窄及支架内血栓形成发生率均较高[1-2]。目前,冠状动脉分叉病变治疗策略大致分为简单策略(即主支置入支架,必要时边支也置入支架)和复杂策略(即各类
关键词(KeyWords): 冠状动脉分叉病变;边支闭塞预测;边支保护;边支补救
基金项目(Foundation):
作者(Author): 宋林林,金哲
参考文献(References):
- [1]Colombo A,Moses JW,Morice MC et al.Randomized study to evaluate sirolimus-eluting stents implanted at coronary bifurcation lesions.Circulation,2004,109(10):1244-1249.
- [2]Stinis CT,Hu SP,Price MJ,et al.Three-year outcome of drugeluting stent implantation for coronary artery bifurcation lesions.Catheter Cardiovasc Interv,2010,75(3):309-314.
- [3]Maeng M,Holm NR,Erglis A,et al.Long-term results after simple versus complex stenting of coronary artery bifurcation lesions:nordic bifurcation study 5-year follow-up results.J Am Coll Cardiol,2013,62(1):30-34.
- [4]Hildick-Smith D,de Belder AJ,Cooter N,et al.Randomized trial of simple versus complex drug-eluting stenting for bifurcation lesions the British Bifurcation Coronary Study:old,new,and evolving strategies.Circulation,2010,121(10):1235-1243.
- [5]Zhang F,Dong L,Ge J.Simple versus complex stenting strategy for coronary artery bifurcation lesions in the drug-eluting stent era:a meta-analysis of randomised trials.Heart,2009,95(20):1676-1681.
- [6]Dou K,Zhang D,Xu B,et al.An angiographic tool for risk prediction of side branch occlusion in coronary bifurcation intervention:the RESOLVE score system(Risk pr Ediction of Side branch Occ Lusion in coronary bifurcation inter V Ention).JACC Cardiovasc Interv,2015,8(1 Pt A):39-46.
- [7]Hahn JY,Chun WJ,Kim JH,et al.Predictors and outcomes of side branch occlusion after main vessel stenting in coronary bifurcation lesions:results from the COBIS II registry(coronary bifurcation stenting).J Am Coll Cardiol,2013,62(18):1654-1659.
- [8]Kralev S,Poerner TC,Basorth D,et al.Side branch occlusion after coronary stent implantation in patients presenting with STelevation myocardial infarction:clinical impact and angiographic predictors.Am Heart J,2006,151(1):153-157.
- [9]Seo JB,Shin DH,Park KW,et al.Predictors for side branch failure during provisional strategy of coronary intervention for bifurcation lesions(from the Korean Bifurcation Registry).Am J Cardiol,2016,118(6):797-803.
- [10]Park DW,Kim YH,Yun SC,et al.Frequency,causes,predictors,and clinical significance of peri-procedural myocardial infarction following percutaneous coronary intervention.Eur Heart J,2013,34(22):1662-1669.
- [11]Chen SL,Zhang JJ,Ye F,et al.Periprocedural myocardial infarction is associated with increased mortality in patients with coronary artery bifurcation lesions after implantation of a drugeluting stent.Catheter Cardiovasc Interv,2015,85 Suppl 1:696-705.
- [12]Zhang D,Xu B,Yin D,et al.Clinical and angiographic predictors of major side branch occlusion after main vessel stenting in coronary bifurcation lesions.Chin Med J(Engl),2015,128(11):1471-1478.
- [13]Zhang D,Xu B,Yin D,et al.Predictors and periprocedural myocardial injury rate of small side branches occlusion in coronary bifurcation intervention.Medicine(Baltimore),2015,94(25):e992.
- [14]Sakamoto N,Hoshino Y,Mizukami H,et al.Intravascular ultrasound predictors of acute side branch occlusion in coronary artery bifurcation lesions just after single stent crossover.Catheter Cardiovasc Interv,2016,87(2):243-250.
- [15]Kini AS,Vengrenyuk Y,Pena J,et al.Plaque morphology predictors of side branch occlusion after provisional stenting in coronary bifurcation lesion:Results of optical coherence tomography bifurcation study(ORBID).Catheter Cardiovasc Interv,2016.[Epub ahead of print]
- [16]王均志,陈红磊,孙立娜,等.边支双导丝在必要性支架技术处理真分叉病变中的边支保护作用.中华临床医师杂志:电子版,2014(1):16-18.
- [17]Burzotta F,Trani C,Sianos G.Jailed balloon protection:a new technique to avoid acute side-branch occlusion during provisional stenting of bifurcated lesions.Bench test report and first clinical experience.Euro Intervention,2010,5(7):809-813.
- [18]Singh J,Patel Y,Depta JP,et al.A modified provisional stenting approach to coronary bifurcation lesions:clinical application of the“jailed-balloon technique”.J Interv Cardiol,2012,25(3):289-296.
- [19]Depta JP,Patel Y,Patel JS,et al.Long-term clinical outcomes with the use of a modified provisional jailed-balloon stenting technique for the treatment of nonleft main coronary bifurcation lesions.Catheter Cardiovasc Interv,2013,82(5):E637-E646.
- [20]陈良龙.冠状动脉分叉病变介入治疗精要.人民卫生出版社,2013:166-169.
- [21]Chen LL,Fan L,Chen ZY,et al.Modified culotte stenting for treatment of complex coronary bifurcation lesions:immediate and9-month outcomes in a pilot study.Chin Med J(Engl),2011,124(13):1943-1950.
- [22]Jin Z,Li L,Wang M,et al.Innovative provisional stenting approach to treat coronary bifurcation lesions:balloon-stent kissing technique.J Invasive Cardiol,2013,25(11):600-604.
- [23]林锡民.球囊支架对吻术对冠状动脉分叉病变的保护作用.实用心脑肺血管病杂志,2016,24(3):111-113.
- [24]李成祥,王琼,高好考,等.20例支架外侧球囊扩张挽救冠状动脉分支疗效和安全性观察.中国介入心脏病学杂志,2013,21(1):8-11.
- [25]Funatsu A,Hirokawa R,Nakamura S.Bailout technique to rescue the abruptly occluded side branch with collapsed true lumen after main vessel stenting.Cardiovasc Interv Ther,2016.[Epub ahead of print]