Sheiban Imad, Gerasimou Argyrios, Bollati Mario, Biondi-Zoccai Giuseppe, Sciuto Filippo, Omedé Pierluigi, Sillano Dario, Trevi Gian Paolo, Moretti Claudio
Division of Cardiology, University of Turin, Turin, Italy.
Catheter Cardiovasc Interv. 2009 Jan 1;73(1):25-31. doi: 10.1002/ccd.21759.
We aimed to conduct a retrospective cohort study focusing on our 5-year experience in the percutaneous treatment of unprotected left main (ULM) trifurcation disease.
Percutaneous treatment of ULM trifurcation remains a challenging and rare procedure for most interventional cardiologists. Moreover, data on long-term outcomes are lacking.
We retrieved all patients with ULM trifurcation disease treated percutaneously at our Institution since 2002, and adjudicated baseline, procedural, and outcome data. The primary end point was the long-term rate of major adverse cardiovascular events (MACE, i.e., cardiac death, myocardial infarction, bypass surgery, or target vessel revascularization).
A total of 27 patients underwent percutaneous coronary intervention with stent implantation for ULM trifurcation disease, with 14 (52%) cases of true trifurcations, i.e., with concomitant significant stenoses of the distal ULM/ostial left anterior descending plus ostial ramus intermedius and ostial circumflex. Bare-metal stents were implanted in 8 (29%) patients and drug-eluting stents (DES) in 26 (96%), with a main branch stent only strategy in 11 (40%), T stenting in 9 (33%), and V stenting in 6 (27%). Procedural and clinical success occurred in 26 (96%), with one postprocedural death. Angiographic follow-up was obtained in 22 patients (81%), and clinical follow-up was completed in all subjects after a median of 28 +/- 17 months, showing overall MACE in 9 (33%), with cardiac death in 4 (15%), myocardial infarction in 1 (4%), coronary artery bypass grafting (CABG) in 4 (15%), and percutaneous target vessel revascularization in 5 (19%). Definite stent thrombosis was adjudicated in 1 (3%) patient. Treatment of a true trifurcation lesion and recurrence of angina during follow-up were significantly associated with an increased risk of MACE (P = 0.029 and P = 0.050, respectively).
Percutaneous treatment of ULM trifurcation disease is feasible, associated with favorable mid-term results, and may be considered given its low invasiveness in patients at high surgical risk or with multiple comorbidities.
我们旨在进行一项回顾性队列研究，重点关注我们在经皮治疗无保护左主干（ULM）分叉病变方面的5年经验。
对于大多数介入心脏病学家而言，经皮治疗ULM分叉病变仍然是一项具有挑战性且罕见的手术。此外，缺乏长期预后的数据。
我们检索了自2002年以来在我们机构接受经皮治疗的所有ULM分叉病变患者，并判定了基线、手术和预后数据。主要终点是主要不良心血管事件（MACE，即心源性死亡、心肌梗死、搭桥手术或靶血管血运重建）的长期发生率。
共有27例患者因ULM分叉病变接受了经皮冠状动脉介入并植入支架，其中14例（52%）为真正的分叉病变，即同时存在ULM远端/左前降支开口加中间支开口和回旋支开口的显著狭窄。8例（29%）患者植入裸金属支架，26例（96%）植入药物洗脱支架（DES），11例（40%）采用仅在主支植入支架的策略，9例（33%）采用T型支架置入术，6例（27%）采用V型支架置入术。26例（96%）手术和临床成功，术后1例死亡。22例患者（81%）获得了血管造影随访，所有受试者在中位时间28±17个月后完成了临床随访，显示9例（33%）发生总体MACE，其中4例（15%）心源性死亡，1例（4%）心肌梗死，4例（15%）冠状动脉搭桥术（CABG），5例（19%）经皮靶血管血运重建。1例（3%）患者判定为明确的支架血栓形成。真正的分叉病变治疗和随访期间心绞痛复发与MACE风险增加显著相关（分别为P = 0.029和P = 0.050）。
经皮治疗ULM分叉病变是可行的，中期结果良好，鉴于其对高手术风险或合并多种疾病患者的低侵入性，可予以考虑。
