Yang Hyoung-Mo, Tahk Seung-Jea, Woo Seong-Ill, Lim Hong-Seok, Choi Byoung-Joo, Choi So-Yeon, Yoon Myeong-Ho, Park Jin-Sun, Zheng Mingri, Hwang Gyo-Seung, Kang Soo-Jin, Shin Joon-Han
Department of Cardiology, Ajou University Medical Center, Suwon, Republic of Korea.
Catheter Cardiovasc Interv. 2009 Jul 1;74(1):76-84. doi: 10.1002/ccd.22020.
We aimed to evaluate long-term outcomes of a modified mini-crush technique for treating bifurcation lesions.
Coronary bifurcation lesions continue to show a relatively high restenosis rate despite the use of a drug-eluting stent (DES).
We enrolled 52 consecutive patients treated with sirolimus-eluting stent implantation using the modified mini-crush technique for 56 coronary bifurcation lesions (MEDINA 1, 1, 1, 89.2%; left main lesion, 28.6%). To minimize crushing, the proximal marker of the side branch (SB) stent was located in contact with the main vessel (MV) stent. After SB stenting, we drew the SB balloon proximally and dilate the SB ostium at a rated burst pressure. After MV stenting, both vessels were redilated at a high pressure before final kissing balloon (FKB) inflation. Clinical and angiographic follow-ups were performed at 9 months.
Immediate procedural success was obtained in all cases including a FKB success rate of 98%. At 9 months, there was no death or myocardial infarction. The incidences of major adverse cardiac events and target lesion revascularization were 11.8 and 7.8%, respectively. The in-stent restenosis (ISR) rate was 14.9% (SB ostium, 10.6%) and most ISRs were of the focal type and the cause of ISR was intimal hyperplasia but not chronic stent recoil by an intravascular ultrasound study. There was one case (2.0%) of late stent thrombosis without any ischemic symptoms during the follow-up period of 9 months.
Modified mini-crush technique provides excellent technical and angiographic success immediately and it also provides acceptable long-term outcomes.
我们旨在评估改良的迷你挤压技术治疗分叉病变的长期疗效。
尽管使用了药物洗脱支架（DES），冠状动脉分叉病变的再狭窄率仍然相对较高。
我们连续纳入了52例患者，他们使用改良的迷你挤压技术植入西罗莫司洗脱支架，治疗56处冠状动脉分叉病变（MEDINA 1, 1, 1，占89.2%；左主干病变，占28.6%）。为尽量减少挤压，边支（SB）支架的近端标记与主支血管（MV）支架接触定位。在SB支架置入后，将SB球囊向近端牵拉，并在额定爆破压力下扩张SB开口处。在MV支架置入后，在最终球囊对吻扩张（FKB）前，对两支血管进行高压再扩张。在9个月时进行临床和血管造影随访。
所有病例均取得即刻手术成功，包括FKB成功率为98%。在9个月时，无死亡或心肌梗死发生。主要不良心脏事件和靶病变血运重建的发生率分别为11.8%和7.8%。支架内再狭窄（ISR）率为14.9%（SB开口处为10.6%），大多数ISR为局灶性类型，血管内超声研究显示ISR的原因是内膜增生而非慢性支架回缩。在9个月的随访期内，有1例（2.0%）发生晚期支架血栓形成，无任何缺血症状。
改良的迷你挤压技术能立即取得优异的技术和血管造影成功，且能提供可接受的长期疗效。
