无保护左主干冠状动脉分叉狭窄：单枚西罗莫司洗脱支架植入术前斑块减容的影响

Unprotected left main coronary artery bifurcation stenosis: impact of plaque debulking prior to single sirolimus-eluting stent implantation.

作者信息

Tanaka Nobuyoshi, Terashima Mitsuyasu, Kinoshita Yoshihisa, Kimura Masashi, Nasu Kenya, Ehara Mariko, Tsuchikane Etsuo, Matsubara Tetsuo, Asakura Yasushi, Katoh Osamu, Suzuki Takahiko

机构信息

Department of Cardiology, Toyohashi Heart Center, 21-1 Gobudori, Oyama-cho, Toyohashi, 441-8530, Japan.

出版信息

J Invasive Cardiol. 2008 Oct;20(10):505-10.

PMID:18829993

Abstract

BACKGROUND

The impact of plaque debulking with directional coronary atherectomy (DCA) prior to single sirolimus-eluting stent (SES) implantation in an unprotected left main coronary artery (LMCA) involving bifurcation stenosis has not been fully evaluated.

METHODS

One hundred and one patients with unprotected LMCA bifurcation lesions treated with single SES implantation (from the LMCA to the left descending coronary artery [LAD] across the left circumflex artery [LCx] ostium) were divided into 2 groups: DCA group (n = 41, plaque debulking with DCA prior to SES implantation) and non-DCA group (n = 60, single SES implantation alone). Clinical outcomes as well as angiographic data at baseline, post procedure and follow up were compared between the two groups.

RESULTS

At 1-year follow up, freedom from major adverse cardiac events was 97.4 +/- 2.6% in the DCA group, and 88.6 +/- 4.4% in the non-DCA group (p = 0.129). Baseline quantitative coronary angiographic analyses revealed that the percent diameter stenosis (%DS) of the LCx was higher in the DCA group than in the non-DCA group (36.8 +/- 21.5% vs. 26.9 +/- 19.2%; p = 0.029). Moreover, the %DS of the LCx after PCI and at 9-month follow up was lower in the DCA group (19.2 +/- 13.1% vs. 28.3 +/- 22.7%; p = 0.034; 20.8 +/- 12.3% vs. 31.9 +/- 21.4%; p = 0.007, respectively). Furthermore, restenosis at the LCx ostium was not observed in the DCA group, but was seen in 5 cases in the non-DCA group (0% vs. 10.2%; p = 0.048).

CONCLUSION

Plaque debulking with DCA prior to single SES implantation effectively reduced restenosis of the LCx ostium in this challenging lesion subset.

摘要

背景

在未受保护的左主干冠状动脉（LMCA）合并分叉狭窄处，先采用定向冠状动脉斑块旋切术（DCA）进行斑块减容，再植入单枚西罗莫司洗脱支架（SES）的影响尚未得到充分评估。

方法

101例接受单枚SES植入治疗（从LMCA穿过左旋支动脉[LCx]开口至左冠状动脉前降支[LAD]）的未受保护的LMCA分叉病变患者被分为两组：DCA组（n = 41，在SES植入前用DCA进行斑块减容）和非DCA组（n = 60，仅行单枚SES植入）。比较两组的临床结局以及基线、术后和随访时的血管造影数据。

结果

在1年随访时，DCA组主要不良心脏事件无发生率为97.4±2.6%，非DCA组为88.6±4.4%（p = 0.129）。基线定量冠状动脉血管造影分析显示，DCA组LCx的直径狭窄百分比（%DS）高于非DCA组（36.8±21.5%对26.9±19.2%；p = 0.029）。此外，DCA组PCI后及9个月随访时LCx的%DS较低（分别为19.2±13.1%对28.3±22.7%；p = 0.034；20.8±12.3%对31.9±21.4%；p = 0.007）。此外，DCA组未观察到LCx开口处再狭窄，但非DCA组有5例出现再狭窄（0%对10.2%；p = 0.048）。