赵杰，吴永健，钱杰，俞梦越，滕思勇，罗彤，宋光远，孙中伟



应用切割球囊联合单支架置入治疗冠状动脉分叉病变的临床观察

赵杰，吴永健，钱杰，俞梦越，滕思勇，罗彤，宋光远，孙中伟

摘要

目的：评价应用切割球囊联合主支血管单支架置入术治疗冠状动脉分叉病变的安全性及有效性。

方法：入选自2012-01至2014-01我院心内科113例住院患者，共121处冠状动脉分叉病变，应用切割球囊对主支血管和分支血管分别进行预扩张处理后，再对主支血管进行药物洗脱支架置入术，观察手术成功率、分支血管血流情况及并发症发生率，9个月后随访主要心血管不良事件（MACE） 情况。

结果： 应用冠状动脉造影定量分析软件测量支架置入前、后主支血管最小管径分别为（2.12±1.07）mm和（3.24±0.87）mm，分支血管最小管径分别为（1.44±0.73）mm和（1.82±0.64）mm，差异均有统计学意义（P＜0.05～0.01）。手术成功率为100%。入选患者中11处（9.1%）分叉病变发生分支血管近端夹层，5处（4.1%）分叉病变出现分支血管心肌梗死溶栓治疗临床试验（TIMI） 血流＜2级，其中1处（0.8%）分叉病变发生分支血管闭塞。平均随访时间（8.3±3.1）个月，其中1例（0.8%）靶病变再次血运重建治疗，无心原性死亡及心肌梗死事件发生。

结论： 应用切割球囊联合主支血管单支架置入对治疗分支血管存在明确病变的冠状动脉分叉病变是安全有效的。

关键词 冠状动脉疾病；血管成形术，经腔，经皮冠状动脉；分叉病变

Objective： To evaluate the safety and efficacy of cutting balloon combining main branch single stent cross-over technique for treating the patients with coronary bifurcation lesions.

Methods： A total of 113 patients with 121 bifurcation lesions treated in our hospital from 2012-01 to 2014-01 were enrolled. Cutting balloon pre-dilation was applied in both main and side branches followed by drug-eluting stent implantation at main branch. The procedural success rates， side branch blood flow status and complications were observed. Follow-up studied for MACE occurrence was conducted at 9 months after the operation.

Results： Quantitative coronary angiography （QCA） presented that the minimum lumen diameters at pre- and post-operation in main branches were （2.12 ± 1.07） mm and （3.24 ± 0.87） mm， in side branches were （1.44 ± 0.73）mm and （1.82 ± 0.64） mm respectively， P＜0.05-0.01， the procedural success rate was 100%. There were 11 （9.1%） lesions with dissection at proximal side branch， 5 （4.1%） lesions with side branch TIMI blood flow＜grade 2 and 1 （0.8%） of them having side branch occlusion. The mean followed-up time was （8.3 ± 3.1） months， 1 （0.8%） lesion had target lesion revascularization and no death， no MI occurred during that period.

Conclusion： Cutting balloon with main branch single stent cross-over technique has been safe and effective for treating coronary bifurcation lesions especially for patients with definite side branch lesions.

Key words Coronary artery disease； Angioplasty， transluminal， percutaneous coronary； Bifurcation lesions

（Chinese Circulation Journal， 2016，31：546.）

冠状动脉分叉病变是指冠状动脉主支和分支血管单独或者同时存在不同程度的狭窄，是冠心病介入治疗中的常见病变，约占经皮冠状动脉介入治疗（PCI）的15%～20%［1， 2］。……