洪浪,王洪,李林锋,尹秋林,廖作银,涂伟玲

• 1:江西省人民医院心内二科

摘要(Abstract)：

目的探讨改良DK-Crush技术(即前送球囊DK-Crush技术)处理冠状动脉真性分叉病变的有效性和安全性。方法本研究连续入选2007年1月至2011年12月在本院住院,冠状动脉造影证实为真性分叉病变(分支血管直径≥2.0 mm)的患者共196例。随机分为两组,每组各98例,其中一组接受经典DK-Crush技术治疗,另外一组接受前送球囊DK-Crush技术治疗。比较两组患者临床特征、病变分布、曝光时间、手术时间、使用球囊数量、造影剂用量、手术相关费用、手术成功率,并记录出院后6个月临床随访时的主要心血管事件(MACE)发生率。结果两组患者基础临床特征差异无显著性,两组患者分叉病变分布差异无显著性。用前送球囊DK-Crush组与经典DK-Crush组患者的主干与分支血管之间的夹角[(54±18)°︰(49±15)°,P=0.10]、主支血管病变长度[(22.5±7.1)mm︰(24.6±7.3)mm,P=0.10]、手术成功率(98%±1%︰99%±1%,P=0.33)、术后即刻分支血管开口部位最小血管直径[(2.72±0.29)mm∶(2.76±0.23)mm,P=0.10]、残余狭窄率(6.8%±2.2%︰6.5%±2.6%,P=0.10)差异均无显著性。前送球囊DK-Crush组与经典DKCrush组比较,患者曝光时间短[(38±11)min∶(50±13)min,P=0.03]、手术时间短[(65±17)min︰(78±18)min,P=0.03]、使用球囊数量少[(1.7±0.4)个︰(2.6±0.7)个,P=0.02]、造影剂使用量小[(68±25)ml︰(83±24)ml,P=0.03]、手术相关费低[(45 120±234)元︰(50284±245)元,P=0.03]。6个月随访时前送球囊DK-Crush组患者的MACE事件发生率(5.7%±2.2%︰5.3%±1.6%,P=0.08)、造影再狭窄率(7.8%±2.6%︰7.5%±2.2%,P=0.10)差异均无显著性。结论改良的DK-Crush技术能显著缩短曝光时间、减少球囊数量,减少患者的手术费用,其6个月随访结果证实了其在有效性及安全性方面均与经典DK-Crush技术相当。

关键词(KeyWords)： 冠状动脉;分叉病变;介入治疗;DK-Crush技术

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 洪浪,王洪,李林锋,尹秋林,廖作银,涂伟玲

参考文献(References)：

• [1]Al Suwaidi J,Yeh W,Cohen HA,et al.Immediate and one-year outcome in patients with coronary bifurcation lesions in the modern era(NHLBI dynamic registry)[J].Am J Cardiol,2001,87(10):1139-1144.
• [2]Chen SL,Ye F,Zhang JJ,et al.DK crush technique:modified treatment of bifurcation lesions in coronary artery[J].Chinese Medical J,2005,118(20):1746-1750.
• [3]Colombo A,Moses JW,Morice MC,et al.Randomized study to evaluate sirolimus-eluting stents implanted at coronary bifurcation lesions[J].Circulation,2004,109(10):1244-1249.
• [4]Gai LY.Intervention for coronary bifurcation lesions:an unsolved techenique problem[J].Chin Circulation J(Chinese),2004,19(4):313-315.
• [5]Hildick-Smith D,de Belder AJ,Cooter N,et al.Randomized trial of simple versus complex drug-eluting stenting for bifurcation lesions.The British Bifurcation Coronary Study:old,new,and evolving strategies[J].Circulation,2010,121(10):1235-1243.
• [6]Chen SL,Santoso T,Zhang JJ,et al.A randomized clinical study comparing double kissing crush with provisional stenting for treatment of coronary bifurcation lesions:results from the DKCRUSH-II(Double Kissing Crush versus Provisional Stenting Technique for Treatment of Coronary Bifurcation Lesions)trial[J].JACC,2011,57(8):914-920.
• [7]Galassi AR,Colombo A,Buchbinder M,et al.Long-term outcomes of bifurcation lesions after implantation of drugeluting stents with the“mini-crush technique”[J].Catheter Cardiovasc Interv,2007,69(7):976-83.
• [8]Ge L,Airoldi F,Iakovou I,et al.Clinical and angiographic outcome following implantation of drug-eluting stent s in bifurcation lesions with the crush technique:importance of final kissing balloon post 2 dilatation[J].J Am Coll Cardiol,2005,46(4):613-620.
• [9]陈绍良,方唯一,魏盟,等.DK-Crush技术治疗真性冠状动脉分叉病变:与经典Crush技术的对比[J].中国介入心脏病学杂志,2007,15(2):61-66.
• [10]Chen SL,Mintz G,Kan J,et al.Serial intravascular ultrasound analysis comparing double kissing and classical crush stenting for coronary bifurcation lesions[J].Catheter Cardiovasc Interv,2011,78(5):729-736.
• [11]Ye F,Zhang JJ,Tian NL,et al.The acute changes of fractional flow reserve in DK(double kissing),crush,and 1-stent technique for true bifurcation lesions[J].J Interven Cardiol,2010,23(4):341-345.
• [12]Chen SL,Zhang JJ,Ye F,et al.Study comparing the double kissing(DK)crush with classical crush for the treatment of coronary bifurcation lesions:the DKCRUSH-1 Bifurcation Study with drug-eluting stents[J].Eur J Clin Invest,2008,38(6):361-371.