Costa Ricardo A, Mintz Gary S, Carlier Stephane G, Lansky Alexandra J, Moussa Issam, Fujii Kenichi, Takebayashi Hideo, Yasuda Takenori, Costa Jose R, Tsuchiya Yoshihiro, Jensen Lisette O, Cristea Ecaterina, Mehran Roxana, Dangas George D, Iyer Sriram, Collins Michael, Kreps Edward M, Colombo Antonio, Stone Gregg W, Leon Martin B, Moses Jeffrey W
Cardiovascular Research Foundation and Columbia University Medical Center, New York, New York 10022, USA.
J Am Coll Cardiol. 2005 Aug 16;46(4):599-605. doi: 10.1016/j.jacc.2005.05.034.
We report intravascular ultrasound (IVUS) findings after crush-stenting of bifurcation lesions.
Preliminary results with the crush-stent technique are encouraging; however, isolated reports suggest that restenosis at the side branch (SB) ostium continues to be a problem.
Forty patients with bifurcation lesions underwent crush-stenting with the sirolimus-eluting stent. Postintervention IVUS was performed in both branches in 25 lesions and only the main vessel (MV) in 15 lesions; IVUS analysis included five distinct locations: MV proximal stent, crush area, distal stent, SB ostium, and SB distal stent.
Overall, the MV minimum stent area was larger than the SB (6.7 +/- 1.7 mm2 vs. 4.4 +/- 1.4 mm2, p < 0.0001, respectively). When only the MV was considered, the minimum stent area was found in the crush area (rather than the proximal or MV distal stent) in 56%. When both the MV and the SB were considered, the minimum stent area was found at the SB ostium in 68%. The MV minimum stent area measured <4 mm2 in 8% of lesions and <5 mm2 in 20%. For the SB, a minimum stent area <4 mm2 was found in 44%, and a minimum stent area <5 mm2 in 76%, typically at the ostium. "Incomplete crushing"--incomplete apposition of SB or MV stent struts against the MV wall proximal to the carina--was seen in >60% of non-left main lesions.
In the majority of bifurcation lesions treated with the crush technique, the smallest minimum stent area appeared at the SB ostium. This may contribute to a higher restenosis rate at this location.
我们报告分叉病变挤压式支架置入术后的血管内超声（IVUS）结果。
挤压式支架技术的初步结果令人鼓舞；然而，个别报告表明，边支（SB）开口处的再狭窄仍然是一个问题。
40例分叉病变患者接受了西罗莫司洗脱支架的挤压式支架置入术。25处病变的两个分支均进行了干预后IVUS检查，15处病变仅对主血管（MV）进行了IVUS检查；IVUS分析包括五个不同位置：MV近端支架、挤压区域、远端支架、SB开口处和SB远端支架。
总体而言，MV的最小支架面积大于SB（分别为6.7±1.7mm²和4.4±1.4mm²，p<0.0001）。仅考虑MV时，56%的病变在挤压区域（而非近端或MV远端支架）发现最小支架面积。同时考虑MV和SB时，68%的病变在SB开口处发现最小支架面积。8%的病变MV最小支架面积<4mm²，20%的病变<5mm²。对于SB，44%的病变最小支架面积<4mm²，76%的病变<5mm²，通常在开口处。在超过60%的非左主干病变中可见“不完全挤压”——SB或MV支架支柱在隆突近端未完全贴靠MV壁。
在大多数采用挤压技术治疗的分叉病变中，最小的最小支架面积出现在SB开口处。这可能导致该部位较高的再狭窄率。
