Kim Young-Hak, Park Seong-Wook, Hong Myeong-Ki, Park Duk-Woo, Park Kyoung-Min, Lee Bong-Ki, Song Jong-Min, Han Ki-Hoon, Lee Cheol Whan, Kang Duk-Hyun, Song Jae-Kwan, Kim Jae-Joong, Park Seung-Jung
The Department of Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
Am J Cardiol. 2006 Jun 1;97(11):1597-601. doi: 10.1016/j.amjcard.2005.12.051. Epub 2006 Apr 7.
We assessed the safety and feasibility of various stenting techniques using the sirolimus-eluting stent (SES) in the treatment of unprotected left main coronary artery (LMCA) bifurcation stenoses. One hundred sixteen patients with unprotected LMCA bifurcation stenoses underwent SES implantation. A simple stenting technique (simple group, n = 67) across the left circumflex artery (LCx) and a complex technique (complex group) comprising "kissing" stenting (n = 24) or a "crush" (n = 25) technique were used. Baseline clinical and angiographic characteristics were similar for the 2 groups, except for more multivessel involvement and narrower LCxs in the complex group. The procedural success rate was 100%. Angiographic restenosis rate at 6 months was lower in the simple group (5.3%) than in the complex group (24.4%, p = 0.024). In the complex group, restenosis rates were similar for the kissing (25.0%) and crush (23.8%) techniques (p = 1.0). There were no incidents of death or myocardial infarction during follow-up (median 18.6 months). Target lesion revascularization was performed in 6 patients only in the complex group (0% vs 12.2%, p = 0.005). At 18 months, survival rates without target lesion revascularization were 100 +/- 0% in the simple group and 85.7 +/- 5.6% in the complex group (p = 0.004). In conclusion, SES implantation for unprotected LMCA bifurcation stenoses appears to be safe and effective. Compared with the complex stenting technique, the simple technique was technically easier and appeared to be more effective in improving long-term outcomes in patients with normal LCxs.
我们评估了使用西罗莫司洗脱支架（SES）治疗无保护左主干冠状动脉（LMCA）分叉狭窄的各种支架置入技术的安全性和可行性。116例无保护LMCA分叉狭窄患者接受了SES植入。采用了一种简单的支架置入技术（简单组，n = 67），即横跨左旋支动脉（LCx）进行支架置入，以及一种复杂技术（复杂组），包括“对吻”支架置入术（n = 24）或“挤压”技术（n = 25）。两组的基线临床和血管造影特征相似，但复杂组多支血管受累更多，LCx更窄。手术成功率为100%。简单组6个月时的血管造影再狭窄率（5.3%）低于复杂组（24.4%，p = 0.024）。在复杂组中，“对吻”技术（25.0%）和“挤压”技术（23.8%）的再狭窄率相似（p = 1.0）。随访期间（中位时间18.6个月）无死亡或心肌梗死事件发生。仅在复杂组有6例患者进行了靶病变血管重建（0%对12.2%，p = 0.005）。18个月时，简单组无靶病变血管重建的生存率为100±0%，复杂组为85.7±5.6%（p = 0.004）。总之，SES植入治疗无保护LMCA分叉狭窄似乎是安全有效的。与复杂支架置入技术相比，简单技术在技术上更容易，并且在改善LCx正常患者的长期预后方面似乎更有效。
