孟晓雪，白明，张钲

冠心病研究

边支血管球囊保护技术在冠状动脉分叉病变中的临床研究

孟晓雪，白明，张钲

目的:观察分叉病变边支血管直径＜2.5 mm的冠状动脉（冠脉）血管病变，主支血管置入支架的同时对边支血管进行预扩球囊保护边支血管技术的可行性及疗效。

方法：选取 2013 -01 至2014-08收住我院心内科治疗的 82例冠心病患者，经冠脉造影证实罪犯血管直径狭窄＞70%的分叉病变，边支血管直径＜2.5 mm。其中40例为试验组，采用主支血管置入支架同时行边支血管预扩张球囊保护技术；42例为对照组，主支血管支架置入时采用钢丝保护技术。对两种术式即刻手术成功率、住院期间及术后9个月主要心血管事件（MACE）事件发生率进行比较。

结果：试验组与对照组比较，经皮冠脉介入治疗（PCI）手术成功率显著升高 （97.5% vs 92.9%， P＜ 0.05） ；手术平均时间、对比剂用量、曝光时间明显减少（P＜ 0.05～ 0.01）；术中边支血管慢血流/无复流及冠脉血管受累发生率较低（2.5 % vs 16.7%, P＜0.01） ；术后 9个月随访期间MACE的发生率降低（2.5% vs 7.1%， P＜0.05）；边支血管再狭窄率及晚期管腔丢失均较低[（0.37±0.23）mm vs（0.53±0.82）mm，P＜ 0.05]。

结论:在分叉病变处理中，边支血管预扩球囊保护边支血管技术成功率高，在不影响主支血管置入支架的同时降低了边支血管闭塞和并发症的发生率，有利于应用于临床治疗。

冠状动脉疾病；血管成形术，经腔，经皮冠状动脉

Objective: To observe the feasibility and effcacy of main branch percuteanous coronary intervention (PCI) with simultaneous branch balloon protection technology in patients with bifurcation branch vessel diameter＜2.5 mm.

Methods: A total of 82 coronary artery disease (CAD) patients treated in our hospital from 2013-01 to 2014-08 were studied. All patients had coronary angiography confrmed bifurcation lesions, with the stenosis≥70% and the branch vessel diameter＜2.5 mm. The patients were divided into 2 groups: Experimental group, the patients received main branch PCI with simultaneous branch balloon protection technology, n=40 and Control group, the patients received main branch PCI with simultaneous steel wire protection technology, n=42. The immediate PCI success rate, hospital stay time and 9 months post-operative MACE occurrence rate were compared between 2 groups.

Results: Compared with Control group, Experimental group showed the higher PCI success rate (97.5% vs 92.9%), P＜0.05, less operation time, lower contrast dosage and X-ray exposure time, P＜0.05-0.01; lower occurrence rates of intra-operative slow fow/ no refow (2.5% vs 16.7%), P＜0.01 and MACE; less branch vessel re-stenosis (0.37±0.23) mm vs (0.53±0.82) mm, P＜0.05.

Conclusion: Branch balloon protection technology had the high success rate for treating the patients with coronary bifurcation lesions, it may reduce the occurrence rate of branch vessel occlusion and complications in clinical practice.

冠状动脉（冠脉）分叉病变在经皮冠脉介入治疗中占 15%～16%，发生率为 10%～30%[1]。如何更好地对分叉病变进行处理一直是冠脉介入治疗中的研究热点。在分叉病变研究中对于选择单支架还是双支架术式的讨论很多。……