摘要
目的:评估改良拘禁球囊保护技术在冠状动脉非左主干分叉病变中预防分支闭塞的有效性。方法:连续入选2015年5月至2019年12月在中国医学科学院阜外医院行经皮冠状动脉介入治疗(PCI)且符合入选标准的患者,冠状动脉造影证实靶病变为非左主干分叉病变。将患者随机分为改良拘禁球囊保护技术组(PBT组)和拘禁导丝保护技术组(JWT组)。记录所有患者的临床资料,比较两组主支置入支架后分支闭塞的发生率、术毕分支TIMI 3级血流的比例、分支重进导丝的比例和成功率、围术期心肌梗死的发生率。结果:共入选432例患者,PBT组与JWT组各216例。PBT组在PCI术中分支闭塞的发生率明显低于JWT组(0.93%vs.4.17%,P=0.03),真性分叉病变PCI术中分支闭塞的发生率也明显低于JWT组(0.58%vs.5.39%,P<0.01)。PBT组1例(0.46%)分支需要重进导丝,并置入支架;JWT组6例(2.78%)需要重进分支导丝,其中2例(33.33%)分支重进导丝失败,4例(66.67%)对分支进行扩张。两组需要重进导丝的比例和再进导丝的成功率、术毕主支和分支TIMI 3级血流的比例以及围术期心肌梗死的发生率、心原性死亡和靶病变再次血运重建发生率的差异均无统计学意义(P均>0.05)。结论:与JWT相比,PBT可有效降低分叉病变介入治疗分支闭塞的发生率,且有降低围术期心肌梗死发生率的趋势。
Objectives:To evaluate the efficacy of protecting ballooning technique(PBT)for preventing the side branch(SB)occlusion in coronary non-left main bifurcation lesions.Methods:All patients who underwent PCI and met the inclusion criteria with angiographically confirmed non-left main bifurcation lesions between May 2015 and December 2019 at Fuwai Hospital were consecutively enrolled.Patients were randomized into jailed wire technique(JWT)group and PBT group.All baseline data were collected and periprocedural outcomes including rate of SB occlusion,percentage of SB TIMI flow grade 3,percentage of SB rewiring and success rate and periprocedural myocardial infarction were compared between the two groups.Results:A total of 432 patients were enrolled and divided into JWT and PBT group at 1:1 ratio(216 patients in each group).There were no significance in baseline demographic data and left ventricular ejection fraction,prior history of hypertension,dyslipidemia and diabetes mellitus and stenosis of main branch(MB)and SB before PCI between the two groups.SB occlusion was defined in 2 patients(0.93%)in PBT group and 9 patients(4.17%)in JWT group(P=0.03).SB rewiring was necessary in 1 patient of PBT group(0.46%)and SB blood flow was successfully restored post provisional stent implantation in this patient.Six patients(2.78%)received SB rewiring in JWT group and SB blood flow was successfully restored in 4 patients(66.67%)and failed in 2 patients(33.33%)post re-dilatation.There were no significant difference in percentage of SB rewiring and success rate.There were no significant difference in both TIMI flow of MB and SB after procedure between two groups.Periprocedural myocardial infarction occurred in 3 patients of PBT group(1.39%)and in 6 patients of JWT group(2.78%),P>0.05.Periprocedural major adverse cardiovascular events including cardiogenic death,myocardial infarction and target lesion revascularization were similar between the two groups.Conclusions:PBT is effective for the prevention of SB occlusion compared with JWT in non-left main bifurcation lesions.PBT technique is associated with a tendency of reduced rate of periprocedural myocardial infarction in this patient cohort.
作者
王曼
刘海波
徐波
卞小丽
刘灵安
胡奉环
陈珏
高立建
邹同强
吴帆
常越
杨跃进
乔树宾
WANG Man;LIU Haibo;XU Bo;BIAN Xiaoli;LIU Ling’an;HU Fenghuan;CHEN Jue;GAO Lijian;ZOU Tongqiang;WU Fan;CHANG Yue;YANG Yuejin;QIAO Shubin(Coronary Heart Disease Center,National Center for Cardiovascular Diseases and Fuwai Hospital,CAMS and PUMC,Beijing(100037),China)
出处
《中国循环杂志》
CSCD
北大核心
2021年第10期966-971,共6页
Chinese Circulation Journal
基金
北京力生心血管健康基金会领航基金项目(LHJJ20144710)。
关键词
分叉病变
改良拘禁球囊保护技术
拘禁导丝技术
分支闭塞
bifurcation lesions
protective ballooning technique
jailed wire technique
side branch occlusion
