Colombo Antonio
EMO Centro Cuore Columbus, and Interventional Cardiology Unit, San Raffaele Hospital, Milan, Italy.
Ital Heart J. 2005 Jun;6(6):475-88.
The introduction of drug-eluting stents has significantly improved the immediate and long-term results following treatment of bifurcation coronary lesions. Despite these improvements, few questions are still without a clear answer. Among them the most important one is the need to use two stents vs provisional side branch stenting in true bifurcations. At present time the approach most frequently applied is to stent the main branch stenting to the side branch only for suboptimal results. In situations when the operator needs two stents as intention to treat we suggest the usage of the "Crush" or "V" technique. These two approaches have been utilized with good immediate and long-term results with sirolimus-eluting stents and with polymer-based paclitaxel-eluting stents. The usage of the "Crush" technique followed by final dilation of the side branch and with kissing balloon inflation has decreased. We recently evaluated results with this technique in 70 patients treated with sirolimus-eluting stents. The 6-month angiographic follow-up was available in 83% of the lesions and restenosis rate was 33% (7% main and side branches and 26% only side branch). No difference was observed in the restenosis rate on the main branch between lesions treated with final kissing balloon inflation and lesions without final kissing inflation (4% in the final kissing group vs 8% in the no final kissing group, p = 1.00). The restenosis rate on the side branch was lower in the final kissing group (17%) in comparison to the no final kissing group (42%) (p = 0.046). Similar results are achieved with polymer-based paclitaxel-eluting stents. The introduction of drug-eluting stents with selective usage of stenting the main and side branches applying the "Crush" or "V" techniques has significantly improved the results compared to bare metal stents in bifurcation lesions.
药物洗脱支架的引入显著改善了冠状动脉分叉病变治疗后的近期和远期效果。尽管有这些改善，但仍有一些问题尚无明确答案。其中最重要的问题是在真性分叉病变中是需要使用双支架还是采用临时边支支架置入术。目前最常用的方法是仅在主支置入支架，仅在边支结果欠佳时才对边支进行支架置入。当术者打算使用双支架进行治疗时，我们建议采用“挤压”或“V”技术。这两种方法在西罗莫司洗脱支架和基于聚合物的紫杉醇洗脱支架的应用中均取得了良好的近期和远期效果。采用“挤压”技术后对边支进行最终扩张并进行球囊对吻扩张的情况有所减少。我们最近评估了70例接受西罗莫司洗脱支架治疗的患者采用该技术的效果。83%的病变有6个月的血管造影随访结果，再狭窄率为33%（主支和边支均为7%，仅边支为26%）。在最终进行球囊对吻扩张的病变和未进行最终球囊对吻扩张的病变之间，主支的再狭窄率无差异（最终对吻组为4%，未进行最终对吻组为8%，p = 1.00）。最终对吻组边支的再狭窄率（17%）低于未进行最终对吻组（42%）（p = 0.046）。基于聚合物的紫杉醇洗脱支架也取得了类似的结果。与裸金属支架相比，采用“挤压”或“V”技术选择性地对主支和边支进行支架置入的药物洗脱支架的引入显著改善了分叉病变的治疗效果。
