徐聪 吴铿

【摘要】 无保护左主干病变是一种极易发生心肌梗死、心力衰竭等情况的高危冠脉病变。随着支架植入技术的发展，经皮冠状动脉介入治疗（PCI）已成为治疗无保护左主干病变的一个重要选择。对吻扩张支架术作为治疗左主干分叉病变的一种手术方式，能够快速有效地完成手术，且相较于其他双支架术式，能够减少冠脉内操作，是一种值得考虑的PCI术式。本文就目前无保护左主干病变PCI治疗及对吻扩张支架术技术应用于无保护左主干分叉病变的安全有效性相关研究进行综述。

【关键词】 无保护左主干病变 冠状动脉分叉病变 经皮冠状动脉支架术 对吻支架术

[Abstract] Unprotected left main coronary artery disease is a kind of high risk coronary artery disease which is prone to myocardial infarction and heart failure. With the development of stent implantation technology， percutaneous coronary intervention （PCI） has been an important option for the treatment of unprotected left main artery disease. As a surgical method for the treatment of left main bifurcation lesions， simultaneous kissing stents is able to complete the surgery quickly and effectively， and can reduce the intracoronary operation compared with other double-stenting surgeries. It is a PCI method worthy of consideration. This paper reviews the current studies on PCI in the treatment of unprotected left main coronary artery disease and the safety and efficacy of simultaneous kissing stents in the the treatment of unprotected left main bifurcation lesions.

[Key words] Unprotected left main coronary artery disease Coronary bifurcation lesions Percutaneous coronary intervention Simultaneous kissing stents

First-authors address： Guangdong Medical Univercity， Zhanjiang 524000， China

doi：10.3969/j.issn.1674-4985.2021.11.044

冠狀动脉左主干病变按病变部位可分为开口病变、体部病变及末端分叉病变，根据供血区域是否具有其他血管（如桥血管，对侧血管丰富的侧支循环）提供血供，分为有保护左主干病变和无保护左主干病变（unprotected left main coronary artery disease， ULMCA）两种类型。

无保护左主干病变指冠状动脉造影显示狭窄50%以上，且前降支或回旋支不存在通畅的桥血管或者无自身右向左良好的侧支循环。临床上，冠状动脉左主干病变占经皮冠状动脉介入治疗（percutaneous coronary intervention， PCI）的4%～6%。近年来，PCI已成为治疗左主干病变的重要手段[1-2]。在治疗无保护左主干分叉病变时，最佳的支架植入方式也依旧值得探讨。随着分叉病变复杂性的增加，临床上倾向于使用双支架术治疗无保护左主干病变，但术者需要根据病变情况及经验等选择手术方式。对……