Adriaenssens Tom, Byrne Robert A, Dibra Alban, Iijima Raisuke, Mehilli Julinda, Bruskina Olga, Schömig Albert, Kastrati Adnan
Deutsches Herzzentrum München and 1. Klinikum rechts der Isar, Technische Universität, Lazarettstrasse 36, 80636 Munich, Germany.
Eur Heart J. 2008 Dec;29(23):2868-76. doi: 10.1093/eurheartj/ehn512. Epub 2008 Nov 11.
Percutaneous treatment of coronary bifurcation disease remains challenging. In patient subsets in which a two-stent strategy is necessary, the culotte technique is a widely used method. We sought to examine the clinical and angiographic outcomes of patients treated in this manner at our institution. As quantitative coronary angiographic analysis using standard measurement programmes is problematic, we used a dedicated bifurcation analysis system.
We prospectively enrolled patients undergoing culotte stenting with drug-eluting stents (Cypher, Endeavor, polymer-free rapamycin-eluting, Taxus) in two German centres. Lesions were classified according to the Medina classification. Angiographic follow-up was scheduled between 6 and 12 months post-index procedure. Clinical follow-up was available up to 12 months. Culotte technique was used in 134 lesions in 132 patients. Of these, 124 (92.5%) represented 'true bifurcation' lesion morphology. Kissing balloon inflation was used in 62% of patients. Procedural angiographic success was achieved in all lesions. Follow-up coronary angiography was performed in 108 (81.8%) patients. Median (IQR) late lumen loss was 0.10 (-0.04-0.38) mm in the proximal main vessel, 0.34 (0.03-0.66) mm in the distal main branch, and 0.30 (-0.01-0.72) mm in the side branch. The incidence of binary angiographic restenosis was 22% for the whole bifurcation lesion, 0% in the proximal main vessel, 9.1% in the distal main branch, and 16% in the side branch. At 12 months, 28 of 132 (21%) patients had undergone target lesion revascularization. The incidence of stent thrombosis (at 1 year) was 1.5%. Predictors of angiographic restenosis were older age, increasing bifurcation angle, more severe distal main branch stenosis, and smaller side branch reference diameter; kissing balloon post-dilatation tended to have a protective effect.
The culotte stenting technique is associated with high procedural success and a relatively low risk of angiographic restenosis. Safety results in our cohort were favourable in terms of a low risk of stent thrombosis.
经皮冠状动脉分叉病变的治疗仍然具有挑战性。在需要采用双支架策略的患者亚组中，裤裙式技术是一种广泛应用的方法。我们试图研究在我们机构接受这种治疗方式的患者的临床和血管造影结果。由于使用标准测量程序进行定量冠状动脉血管造影分析存在问题，我们使用了专门的分叉分析系统。
我们在两个德国中心前瞻性纳入了接受药物洗脱支架（西罗莫司洗脱支架、安珂洗脱支架、无聚合物雷帕霉素洗脱支架、紫杉醇洗脱支架）裤裙式支架置入术的患者。病变根据梅迪纳分类法进行分类。血管造影随访安排在索引手术6至12个月后。临床随访最长可达12个月。132例患者的134处病变采用了裤裙式技术。其中，124处（92.5%）表现为“真正的分叉”病变形态。62%的患者使用了球囊对吻扩张。所有病变均实现了手术血管造影成功。108例（81.8%）患者接受了随访冠状动脉血管造影。近端主血管的中位（四分位间距）晚期管腔丢失为0.10（-0.04-0.38）mm，远端主分支为0.34（0.03-0.66）mm，侧支为0.30（-0.01-0.72）mm。整个分叉病变的二元血管造影再狭窄发生率为22%，近端主血管为0%，远端主分支为9.1%，侧支为16%。在12个月时，132例患者中有28例（21%）接受了靶病变血管重建。支架血栓形成（1年时）的发生率为1.5%。血管造影再狭窄的预测因素为年龄较大、分叉角度增加、远端主分支狭窄更严重以及侧支参考直径较小；球囊对吻后扩张往往具有保护作用。
裤裙式支架置入技术与较高的手术成功率和相对较低的血管造影再狭窄风险相关。我们队列中的安全性结果在支架血栓形成风险较低方面是有利的。
Zotero 插件