Radke Peter W, Jain Deepak, Conrad Anja, Thomsen Christina, Remmel Marko, Kurowski Volkhard, Schunkert Heribert, Hartmann Franz
Medical Clinic II, University of Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany.
Clin Res Cardiol. 2008 Apr;97(4):260-5. doi: 10.1007/s00392-007-0619-4. Epub 2007 Nov 28.
Treatment of coronary bifurcation lesions (CBL) remains challenging. This study sought to evaluate a novel dedicated stent system (Frontier stent) by angiographic and clinical comparison with the provisional T-stenting technique using drug-eluting (DES) and bare metal stents (BMS). The study group comprised 105 CBL in 105 patients. 35 consecutive CBL were treated with the Frontier system. The control group of 70 CBL (35 DES, 35 BMS) was pair matched with the former group stratified by the type of CBL (Medina classification) and the reference diameter of the main branch (MB). Clinical, procedural, and quantitative angiographic data (QCA) were obtained in all patients. A follow-up angiography 6 +/- 2-month post-index intervention was performed in 84/105 (80%) patients, clinical 6-month follow-up was available in all patients (100%). All Frontier stent procedures were clinically and angiographically successful. Post-procedural QCA analysis of the MB and the side branches revealed comparable minimal lumen diameters (MLDs) between groups. Moreover, contrast use and radiation exposure were not different between groups. DES use, however, was associated with a significantly lower late lumen (LL) loss in the main and the side branch as compared to the Frontier stent and BMS group. Likewise, MACE rates were lowest in the DES group (6%, P < 0.05 vs. BMS) as compared to the Frontier stent (9%) and the BMS group (16%). The Frontier stent accomplishes treatment of CBL with excellent acute clinical, procedural, and angiographic results. Provisional T-stenting using DES provides superior clinical and angiographic long-term results as compared to BMS and Frontier stents. The results of next generation CBL systems combining a dedicated specific CBL design with DES surfaces are to be awaited.
冠状动脉分叉病变（CBL）的治疗仍然具有挑战性。本研究旨在通过血管造影和临床比较，评估一种新型专用支架系统（Frontier支架）与使用药物洗脱支架（DES）和裸金属支架（BMS）的临时T型支架技术。研究组包括105例患者的105处CBL。连续35处CBL采用Frontier系统治疗。对照组的70处CBL（35处DES，35处BMS）与前一组按CBL类型（Medina分类）和主支（MB）的参考直径进行配对匹配。在所有患者中获取临床、手术和定量血管造影数据（QCA）。84/105（80%）例患者在首次干预后6±2个月进行了随访血管造影，所有患者（100%）均有6个月的临床随访。所有Frontier支架手术在临床和血管造影方面均获成功。对MB和侧支进行术后QCA分析显示，两组之间的最小管腔直径（MLD）相当。此外，两组之间的造影剂使用和辐射暴露无差异。然而，与Frontier支架和BMS组相比，DES的使用与主支和侧支中显著更低的晚期管腔（LL）丢失相关。同样，与Frontier支架组（9%）和BMS组（16%）相比，DES组的主要不良心血管事件（MACE）发生率最低（6%，P<0.05对比BMS）。Frontier支架在治疗CBL方面取得了优异的急性临床、手术和血管造影结果。与BMS和Frontier支架相比，使用DES的临时T型支架提供了更好的临床和血管造影长期结果。结合专用特定CBL设计与DES表面的下一代CBL系统的结果有待观察。
