Department of Cardiology, Athens Euroclinic, Athens, Greece.
Circ Cardiovasc Interv. 2009 Oct;2(5):409-15. doi: 10.1161/CIRCINTERVENTIONS.109.868091. Epub 2009 Sep 22.
Several trials have addressed whether bifurcation lesions require stenting of both the main vessel and side branch, but uncertainty remains on the benefits of such double versus single stenting of the main vessel only.
We have conducted a meta-analysis of randomized trials including patients with coronary bifurcation lesions who were randomly selected to undergo percutaneous coronary intervention by either double or single stenting. Six studies (n=1642 patients) were eligible. There was increased risk of myocardial infarction with double stenting (risk ratio, 1.78; P=0.001 by fixed effects; risk ratio, 1.49 with Bayesian meta-analysis). The summary point estimate suggested also an increased risk of stent thrombosis with double stenting, but the difference was not nominally significant given the sparse data (risk ratio, 1.85; P=0.19). No obvious difference was seen for death (risk ratio, 0.81; P=0.66) and target lesion revascularization (risk ratio, 1.09; P=0.67).
Stenting of both the main vessel and side branch in bifurcation lesions may increase myocardial infarction and stent thrombosis risk compared with stenting of the main vessel only.
已有多项试验探讨了分叉病变是否需要对主血管和分支同时进行支架置入，但对于主血管的双支架与单支架置入相比是否具有优势仍存在不确定性。
我们对包括分叉病变患者的随机试验进行了荟萃分析，这些患者被随机选择接受双支架或单支架经皮冠状动脉介入治疗。共有 6 项研究（n=1642 例患者）符合入选标准。双支架置入组心肌梗死风险增加（风险比，1.78；P=0.001，固定效应；贝叶斯荟萃分析风险比，1.49）。汇总点估计提示双支架置入组支架内血栓形成风险也增加，但由于数据稀疏，差异无统计学意义（风险比，1.85；P=0.19）。双支架置入组的死亡（风险比，0.81；P=0.66）和靶病变血运重建（风险比，1.09；P=0.67）风险无明显差异。
与仅对主血管进行支架置入相比，在分叉病变中对主血管和分支同时进行支架置入可能会增加心肌梗死和支架内血栓形成的风险。
