Terrence Donnelly Heart Center, Division of Cardiology, St. Michael's Hospital, Toronto, Ontario, Canada.
J Interv Cardiol. 2013 Apr;26(2):145-52. doi: 10.1111/j.1540-8183.2013.12022.x. Epub 2013 Feb 13.
Long-term outcome after bifurcation stenting with drug-eluting stents (DES) for obstructive coronary artery disease is poorly understood. In this study, we report 6-9-month angiographic follow-up and long-term clinical outcomes after implantation of drug-eluting stents by crush and kissing stent technique for coronary bifurcation lesions.
Consecutive patients undergoing bifurcation stenting with DES by crush or kissing stent technique were enrolled in a prospective registry. Angiographic follow-up was obtained at 6-9 months and clinical follow-up completed for a median of 38 months.
A total of 86 patients participated in the study. Bifurcation stenting by crush technique was performed in 73 (85%) and by kissing stent in 13 (15%) patients. Stenting of left main bifurcation was applied in 24 (28%) patients. Angiographic follow-up was completed in 75 (87%) patients and showed restenosis in the main for 8 (11%) and side branch for 20 (27%) patients. Clinical follow-up was available for a median duration of 38 months. During follow-up, 2 (2%) patients died, 4 (5%) experienced myocardial infarction (MI), and 11 (13%) underwent target vessel revascularization (TVR) with an overall major adverse cardiac event (MACE) rate of 16%. In left main cohort, angiographic restenosis occurred in 9 (37%) patients, and 3 (12%) patients required TVR. There were no deaths or stent thrombosis. A comparison of crush and kissing stent technique showed significantly higher angiographic restenosis with crush (26% vs 13% in kissing stent patients, P = 0.046) and 95% of restenosis in crush group involved ostium of the side branch. There was no difference in clinical outcomes between the crush and kissing stent groups. Final kissing balloon dilatation (FKB) was successful in 65 (89%) patients in the crush group and associated with a significant reduction in MACE (8% in FKB successful vs 37% in FKB unsuccessful, P = 0.04) during follow-up.
Bifurcation stenting with crush or kissing stent technique is safe and associated with a low rate of TLR and MACE on long-term follow-up. Crush stenting is associated with a significantly higher rate of side branch restenosis compared to kissing stent technique. FKB is associated with significant reduction in MACE during follow-up.
药物洗脱支架（DES）治疗阻塞性冠状动脉疾病的长期结果尚不清楚。本研究报告了采用挤压和吻合法进行冠状动脉分叉病变支架置入术的 6-9 个月血管造影随访和长期临床结果。
连续入选接受 DES 行分叉支架术的患者，按挤压或吻合法进行前瞻性登记。在 6-9 个月时进行血管造影随访，中位随访时间为 38 个月。
共 86 例患者参与研究。73 例（85%）患者采用挤压法行分叉支架术，13 例（15%）采用吻合法。24 例（28%）患者行左主干分叉支架术。75 例（87%）患者完成血管造影随访，主支再狭窄 8 例（11%），侧支再狭窄 20 例（27%）。中位随访时间 38 个月。随访期间，2 例（2%）患者死亡，4 例（5%）发生心肌梗死（MI），11 例（13%）患者行靶血管血运重建（TVR），总体主要不良心脏事件（MACE）发生率为 16%。左主干组中，9 例（37%）患者出现血管造影再狭窄，3 例（12%）患者需要 TVR。无死亡或支架血栓形成。挤压法与吻合法的比较显示，挤压法的血管造影再狭窄率明显较高（挤压法组为 26%，吻合法组为 13%，P=0.046），且挤压法组 95%的再狭窄均发生在侧支开口处。挤压法和吻合法组之间临床结果无差异。在挤压法组中，65 例（89%）患者最终行球囊扩张（FKB）成功，随访期间 MACE 显著降低（FKB 成功组为 8%，FKB 失败组为 37%，P=0.04）。
采用挤压或吻合法进行分叉支架术是安全的，长期随访显示 TLR 和 MACE 发生率较低。与吻合法相比，挤压法与侧支再狭窄率显著升高相关。FKB 与随访期间 MACE 的显著降低相关。
