PCI边支保护时切割球囊与补救性拘禁球囊的应用比较
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摘要
目的比较冠脉真性分叉病变患者在PCI治疗过程中,使用切割球囊和补救性拘禁球囊两种边支保护方法对边支的保护效果。方法选取102例冠脉真性分叉病变患者,依据不同的边支保护方法,分为应用切割球囊保护边支组(n=47)和应用补救性拘禁球囊保护边支组(n=55) 2组,2组在完成主支支架置入后,观察及比较边支血流TIMI、MBG分级和边支开口血管C-F型夹层发生率等指标。结果完成主支支架置入后,应用切割球囊保护边支组边支TIMI、MBG分级达到3级的患者比例为85.1%,应用补救性拘禁球囊保护边支组为69.1%,差异有统计学意义(P<0.05);应用切割球囊保护边支组边支血管夹层发生率为0,应用补救性拘禁球囊保护边支组为12.7%,差异有统计学意义(P <0.05)。结论对于适宜的冠脉真性分叉病变患者在PCI治疗过程中对边支进行保护时,使用切割球囊技术可以减少边支血管的损伤.
Objective To compare the effects of side branch protection by cutting balloon and remedial detaining balloon protection side branch in patients with true bifurcation of coronary artery during PCI treatment.Methods 102 patients with true bifurcation of coronary arteries were retrospectively analyzed. According to different side protection methods, they were divided into two groups: the cutting balloon protection side branch group(n =47) and the remedial detained balloon protection side branch group(n = 55). After the completion of the main support stent placement, we observed and compared the TIMI and MBG grades of the collateral vessels and the incidence of C-F type intersection of the collateral vessels in the two groups. Results After the placement of the main support bracket, the proportion of patients whose TIMI and MBG grades reached level 3 in the edge branch protection group with cutting balloon was 85.1%, and 69.1% in the side branch group applied with remedial detentions balloon protection. There was a statistically significant difference(P<0.05). The incidence of collateral vessel dissection in the edge branch protection group with cutting balloon was 0,and 12.7% in the side group of applied remedial detention balloon protection; there was a statistical difference(P <0.05). Conclusion For patients with appropriate true bifurcation of coronary arteries, it is necessary to protect the side branches during PCI treatment, and the use of cutting balloon technique can reduce collateral vessel damage.
Objective To compare the effects of side branch protection by cutting balloon and remedial detaining balloon protection side branch in patients with true bifurcation of coronary artery during PCI treatment.Methods 102 patients with true bifurcation of coronary arteries were retrospectively analyzed. According to different side protection methods, they were divided into two groups: the cutting balloon protection side branch group(n =47) and the remedial detained balloon protection side branch group(n = 55). After the completion of the main support stent placement, we observed and compared the TIMI and MBG grades of the collateral vessels and the incidence of C-F type intersection of the collateral vessels in the two groups. Results After the placement of the main support bracket, the proportion of patients whose TIMI and MBG grades reached level 3 in the edge branch protection group with cutting balloon was 85.1%, and 69.1% in the side branch group applied with remedial detentions balloon protection. There was a statistically significant difference(P<0.05). The incidence of collateral vessel dissection in the edge branch protection group with cutting balloon was 0,and 12.7% in the side group of applied remedial detention balloon protection; there was a statistical difference(P <0.05). Conclusion For patients with appropriate true bifurcation of coronary arteries, it is necessary to protect the side branches during PCI treatment, and the use of cutting balloon technique can reduce collateral vessel damage.
引文
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[12]熊然,刘文娴,陈立颖.应用切割球囊与普通球囊治疗分叉病变的安全有效性分析[J].心肺血管病杂志,2015,34(1):15-18.
[13]张晓雪,郑媛婕,杜作义.医源性冠状动脉夹层的危险因素分析及急诊处理[J].中国心血管病研究杂志,2016,14(11):1016-1018.
[14]李飒,王慧峰,周文燕.小外径球囊代替保护导丝完成冠脉分叉病变的临床分析[J].中国心血管病研究杂志,2011,10(9):753-755.
[15]赖碁,光雪峰,方杰.补救性拘禁球囊技术在PCI边支保护时的应用[J].昆明医科大学学报,2018,39(8):39-42.
[2]SAMIN K,SHARMA.Simultaneous kissing durg-eluting stent technique for precutaneous treatment of bifurcation lesions in large-size vessels[J].Catheterization and Cardiovascular Intervention,2005,10(2):10-16.
[3]ZAMANI P,KINLAY S.Long-lerm risk of clinical events from stenting side branches of coronary bifurcation lesions with drugeluting and bare-metal stents:an observational meta-analysis[J].Catheter Cardiovasclnterv[J]2011,77(2):202-212.
[4]葛均波,徐永健,王辰主编.内科学(第九版)[M].北京:人民卫生出版社,2018:223-224.
[5]陈纪林主编.冠状动脉分叉病变的介入治疗[M].北京:人民卫生出版社,2008:2-3.
[6]The TIMI Study Group.The thrombolysis is myocardial infarction(TIMI)trial:phase I findings[J].N Engl J Med,1985,13(6):570-573.
[7]连环,杨峻青,陈竹君.急性心肌梗死急诊介入治疗中血栓抽吸治疗对预后的影响[J].中华医学杂志,2011,40(91):4745-4747.
[8]HUBER M S,MOONEY J F,MADISON J.Use of a morphologic classification to predict clinical outcome after dissection from coronary angioplasty[J].Am J Cardiol,199l,6(8):467-471.
[9]陈纪林主编.冠状动脉分叉病变的介入治疗[M].北京:人民卫生出版社,2008:4-17.
[10]李为民,霍勇,吕树铮主编.冠心病介入治疗策略与技巧[M].北京:人民卫生出版社,2007:81-82.
[11]马玉良,王伟民,刘健.分支切割球囊预扩张联合分支球囊保护技术在分叉病变中的应用探讨[J].中国介入心脏病学杂志,2017,25(2):92-95.
[12]熊然,刘文娴,陈立颖.应用切割球囊与普通球囊治疗分叉病变的安全有效性分析[J].心肺血管病杂志,2015,34(1):15-18.
[13]张晓雪,郑媛婕,杜作义.医源性冠状动脉夹层的危险因素分析及急诊处理[J].中国心血管病研究杂志,2016,14(11):1016-1018.
[14]李飒,王慧峰,周文燕.小外径球囊代替保护导丝完成冠脉分叉病变的临床分析[J].中国心血管病研究杂志,2011,10(9):753-755.
[15]赖碁,光雪峰,方杰.补救性拘禁球囊技术在PCI边支保护时的应用[J].昆明医科大学学报,2018,39(8):39-42.