Barlis Peter, Wong Michael C G, Clark David J
Royal Brompton Hospital, Department of Invasive Cardiology, Sydney St., London SW36NP, United Kingdom.
Heart Lung Circ. 2007;16 Suppl 3:S34-8. doi: 10.1016/j.hlc.2007.04.003. Epub 2007 Jul 2.
Unprotected left main stenosis greater than 50% has traditionally been managed with coronary artery bypass surgery. There is now emerging evidence to support a percutaneous strategy adopting drug-eluting stents, especially in patients at high risk for surgery. This paper will review recent outcomes of both bare-metal and drug-eluting stent use for unprotected left main stenosis and summarise results of an Australian registry. Results of studies comparing the percutaneous approach to surgery will also be reviewed together with ESC and AHA/ACC current guidelines. Although percutaneous intervention of unprotected left main has been shown to be a safe and feasible procedure, unanswered questions remain. Large multi-centre randomised trials underway comparing percutaneous to surgical intervention will help clarify these ongoing issues.
传统上，对于大于50%的无保护左主干狭窄，一直采用冠状动脉旁路移植术进行治疗。现在有新出现的证据支持采用药物洗脱支架的经皮治疗策略，尤其是在手术高危患者中。本文将回顾裸金属支架和药物洗脱支架用于无保护左主干狭窄的近期疗效，并总结澳大利亚一项登记研究的结果。还将回顾比较经皮治疗与手术治疗的研究结果以及欧洲心脏病学会（ESC）和美国心脏协会/美国心脏病学会（AHA/ACC）的现行指南。尽管已证明对无保护左主干进行经皮干预是一种安全可行的方法，但仍存在一些未解决的问题。正在进行的比较经皮治疗与手术干预的大型多中心随机试验将有助于阐明这些悬而未决的问题。
