切割球囊对吻扩张与支架术治疗分叉病变的比较研究Comparison of kissing dilating by cutting balloon and stenting for patients with bifurcated lesions
陈绍良,段宝祥,叶飞,周陵,林松
摘要(Abstract)：
目的 探讨切割球囊与普通球囊对吻扩张治疗分叉病变的疗效及安全性。方法 34例真性分叉病变患者被分配到切割球囊对吻组 (13例 )和支架组 (2 1例 )。术前及术后即刻行冠状动脉内超声检查 ,测定血管最小内径 ,血管外弹力膜面积 ,血管腔面积 ,斑块面积 ,直径和面积狭窄百分比。结果 与支架组相比 ,切割球囊组病变以前降支 (LAD)和第一对角支 (D1) (4 3 5 %vs 2 8 9% ,P<0 0 1)处多见 ,右冠状动脉 (RCA)和后降支处 (PDA)少见 (12 1%vs 35 0 % ,P =0 0 1)。切割球囊组患者左心室射血分数比支架组低 (5 7 6 %vs 6 7 6 % ,P =0 0 2 )。支架组患者中 14例共 2 8个支架同时置入主干和分支内 ,仅在主干或分支一侧血管内植入支架 7例 ,最大扩张压力为 14 18 5 5kPa,2 0例患者接受IVUS检查 ,主干血管内最终残余狭窄为 2 3 6 %。切割球囊组 10例患者先在主干和分支内进行切割球囊交替扩张 ,3例患者只在主干内行切割球囊扩张 ,最后对吻扩张时的平均压力为 810 6kPa ,13例患者全部接受IVUS检查 ,IVUS测定主干血管内最终残余狭窄为 10 8%。切割球囊组与支架组扩张前即刻血管腔截面积分别为 (2 31± 1 2 0 )mm2 和 (2 36± 1 2 3)mm2 ,扩张后分别为 (6 4 2±1 0 1)mm2 和 (6 5 1± 1 0 7)mm2 ;两组扩张后
关键词(KeyWords)： 切割球囊;分叉病变;血管内超声;支架
基金项目(Foundation):
作者(Author): 陈绍良,段宝祥,叶飞,周陵,林松
参考文献(References)：
- 1RenkinJ ,WijinsW ,HanetC ,etal.Angioplastyofcoronarybifurcationstenoses.CathetCardiovascDiagn,1991,22:167173.
- 2WhitlowPL ,CowleyM ,BassT ,etal.Riskofhighspeedrotationalatherectomyinbifurcationlesions.JAmCollCardiol,1993,21:445A .
- 3ColomboA ,GaglioneA ,NakamuraS ,etal.“kissing”stentsforbifurcationalcoronarylesions.CathetCardiovascDiagn,1993,22:16421646.
- 4CarrieD ,ElbazM ,DambrinG ,etal.Coronarystentingofbifurcationlesionsusing“T”or“reverseY”configurationwithWiktorstent.AmJCardiol,1998,82:14181421.
- 5ChevalierB ,GlattB ,RoyerT ,etal.Placementofcoronarystentsinbifurcationlesionsbythe“Culotte”technique.AmJCardiol,1998,82:943949.
- 6BarathP ,FischbeinMC ,VarisJK ,etal.Anovelapproachtopercutaneousangioplasty.AmJCardiol,1991,68:12491252.
- 7BonanR ,RoosePC ,SuttorpMJ ,etal.Cuttingballoonglobalrandomizedrandomizedtrial:restenosisandrevascularizationrate.Circulation,1997,96:324326.
- 8MintzG ,PopmaJ,PichardA ,etal.Intravascularultrasoundpredictorsofrestenosisafterpercutaneoustransluminalcoronaryrevascularization.JAmCollCardiol,1996,27:16781687.
- 9SuzukiT ,HosokawaH ,TakabashiO ,etal.Comparisonoftherestenosismechanismofcuttingballoonangioplastyandplainoldballoonangioplasty:Aserialintravascularultrasoundstudy.JACC ,1998,31:498A .