Moussa Issam, Costa Ricardo A, Leon Martin B, Lansky Alexandra J, Lasic Zoran, Cristea Ecaterina, Trubelja Nenad, Carlier Stephane G, Mehran Roxana, Dangas George D, Weisz Giora, Kreps Edward M, Collins Michael, Stone Gregg W, Moses Jeffrey W
Cardiovascular Research Foundation and New York Presbyterian Hospital, Columbia University Medical Center, New York, New York, USA.
Am J Cardiol. 2006 May 1;97(9):1317-21. doi: 10.1016/j.amjcard.2005.11.072. Epub 2006 Mar 20.
The "crush technique" has been proposed as an alternative approach to treat bifurcation lesions because of its predictability and high procedural success rate. However, few data are available regarding its safety and long-term efficacy. We report the long-term clinical outcomes of patients with coronary bifurcation lesions treated with sirolimus-eluting stents using the crush technique. From April 2003 to May 2004, 120 patients with coronary bifurcation lesions were treated with sirolimus-eluting stents using the crush technique. Six months of clinical follow-up was completed in 95.8% of patients. Mean patient age was 64 years; 36% had diabetes mellitus, and the left anterior descending artery/diagonal was the most frequent bifurcation location (69%). Final kissing balloon inflation was performed in 87.5% of patients. Compared with the main vessel, side branch lesions were shorter, with a smaller reference diameter and final in-stent minimum lumen diameter. Procedural success was achieved in 97.5%. At 30 days of follow-up, 1 patient had died of noncardiac causes and 2 patients (1.7%) had subacute stent thrombosis. At 6 months of follow-up, target lesion revascularization was required in 13 patients (11.3%), all of whom had focal restenosis predominantly at the side branch ostium. In conclusion, the crush technique with final kissing balloon inflation can be safely used by experienced operators to treat highly complex bifurcation lesions with sirolimus-eluting stents. The safety profile of this technique is similar to that of other bifurcation stenting techniques reported thus far. Nonetheless, despite the excellent patency rates of the main vessel, the need for revascularization at the ostium of the side branch was not fully eliminated.
“挤压技术”因其可预测性和较高的手术成功率，已被提议作为治疗分叉病变的一种替代方法。然而，关于其安全性和长期疗效的数据却很少。我们报告了使用挤压技术用西罗莫司洗脱支架治疗冠状动脉分叉病变患者的长期临床结果。2003年4月至2004年5月，120例冠状动脉分叉病变患者使用挤压技术用西罗莫司洗脱支架进行了治疗。95.8%的患者完成了6个月的临床随访。患者平均年龄为64岁；36%患有糖尿病，左前降支/对角支是最常见的分叉部位（69%）。87.5%的患者进行了最终球囊对吻扩张。与主血管相比，分支病变较短，参考直径和最终支架内最小管腔直径较小。手术成功率为97.5%。在随访30天时，1例患者死于非心脏原因，2例患者（1.7%）发生亚急性支架血栓形成。在随访6个月时，13例患者（11.3%）需要进行靶病变血管重建，所有这些患者主要在分支开口处出现局灶性再狭窄。总之，经验丰富的术者可以安全地使用最终球囊对吻扩张的挤压技术，用西罗莫司洗脱支架治疗高度复杂的分叉病变。该技术的安全性与迄今为止报道的其他分叉支架置入技术相似。尽管如此，尽管主血管的通畅率极佳，但分支开口处的血管重建需求并未完全消除。
