Karvouni E, Di Mario C, Nishida T, Tzifos V, Reimers B, Albiero R, Corvaja N, Colombo A
Department of Interventional Cardiology, Centro Cuore Columbus, San Raffaele Hospital, Milan, Italy.
Catheter Cardiovasc Interv. 2001 May;53(1):12-20. doi: 10.1002/ccd.1122.
The ideal catheter-based intervention for treatment of coronary lesions at bifurcation site still has to be defined. The aim of the study was to assess the acute and long-term outcome after treatment of bifurcation lesions with directional atherectomy (DCA) and stenting in comparison with stenting alone. Thirty-one consecutive patients treated for bifurcation coronary lesions (62 lesions) with DCA and stenting in at least one branch (DCA group) were compared with a matched group of 31 patients with bifurcation coronary lesions (62 lesions) treated with stenting alone in at least one branch (non-DCA group). Procedural success was 87.1% in the DCA group compared with 100% in the non-DCA group (P = 0.03). In-hospital major adverse cardiac events (MACE) occurred only in the DCA group (12.9% vs. 0%, P = 0.03), mainly non-Q-wave myocardial infarction. After the procedure, minimum lumen diameter (MLD) and acute gain were significantly greater (P = 0.004 and P = 0.05, respectively) and % diameter stenosis was significantly lower (P = 0.05) in the main branch in the DCA group. At follow-up angiogram, MLD in the main branch was still significantly greater in the DCA group compared to the non-DCA group (2.31 vs. 1.65, respectively, P = 0.04), with no significant difference in late loss and loss index between the two groups. Restenosis rate was 28.8% in the DCA group vs. 43.5% in the non-DCA group (P = 0.13). The incidence of follow-up MACE was 29% in the DCA group compared with 48.4% in the non-DCA group, mainly due to target lesion revascularization. In conclusion, treatment of bifurcation coronary lesions with DCA and stenting was associated with greater acute gain after the procedure and greater MLD at follow-up in the main branch compared with stenting alone. Procedural myocardial infarction was more frequent in the DCA group. Restenosis rates and follow-up MACE were lower following DCA and stenting, without reaching any statistical significance.
用于治疗冠状动脉分叉病变的理想导管介入治疗方法仍有待确定。本研究的目的是评估与单纯支架置入术相比，采用定向旋切术（DCA）和支架置入术治疗分叉病变后的急性和长期疗效。将31例连续接受至少一个分支的DCA和支架置入术治疗冠状动脉分叉病变（62处病变）的患者（DCA组）与31例匹配的至少一个分支接受单纯支架置入术治疗冠状动脉分叉病变（62处病变）的患者（非DCA组）进行比较。DCA组的手术成功率为87.1%，而非DCA组为100%（P = 0.03）。住院期间主要不良心脏事件（MACE）仅发生在DCA组（12.9%对0%，P = 0.03），主要是非Q波心肌梗死。术后，DCA组主支的最小管腔直径（MLD）和急性增加量显著更大（分别为P = 0.004和P = 0.05），直径狭窄百分比显著更低（P = 0.05）。在随访血管造影中，DCA组主支的MLD仍显著大于非DCA组（分别为2.31对1.65，P = 0.04），两组之间的晚期丢失和丢失指数无显著差异。DCA组的再狭窄率为28.8%，非DCA组为43.5%（P = 0.13）。DCA组随访MACE的发生率为29%，而非DCA组为48.4%，主要是由于靶病变血运重建。总之，与单纯支架置入术相比，采用DCA和支架置入术治疗冠状动脉分叉病变术后急性增加量更大，随访时主支的MLD更大。DCA组的手术心肌梗死更频繁。DCA和支架置入术后的再狭窄率和随访MACE更低，但未达到任何统计学意义。
