Kappetein Arie Pieter, Head Stuart J, Osnabrugge Ruben L J, van Mieghem Nicolas M
Department of Cardio-Thoracic Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands..
Department of Cardio-Thoracic Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands.
Semin Thorac Cardiovasc Surg. 2014 Autumn;26(3):187-91. doi: 10.1053/j.semtcvs.2014.09.004. Epub 2014 Sep 17.
Revascularization with coronary artery bypass graft surgery is the choice of therapy in patients with left main (LM) coronary artery stenosis. During the last decade, the introduction of drug-eluting stents, together with antiplatelet and antithrombotic treatments, has improved the outcome of percutaneous coronary interventions (PCIs) by reducing the number of repeat revascularizations and the risk of stent thrombosis. Many institutions inside and outside the United States have adopted stent treatment of unprotected LM coronary artery disease as a more routine strategy. However, coronary bypass surgery has improved as well by using more arterial grafts, better perioperative care, and optimizing medical treatment postoperatively. The advances in stent technique may reduce the gap between coronary surgery and PCIs further, but the results of the Evaluation of Xience Prime versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization study, randomizing patients with LM coronary artery disease between coronary bypass grafting and PCIs, will be needed to test whether PCIs is noninferior to coronary bypass surgery.
对于左主干（LM）冠状动脉狭窄患者，冠状动脉旁路移植手术进行血运重建是治疗的选择。在过去十年中，药物洗脱支架的引入，连同抗血小板和抗血栓治疗，通过减少重复血运重建的次数和支架血栓形成的风险，改善了经皮冠状动脉介入治疗（PCI）的结果。美国国内外的许多机构已将无保护左主干冠状动脉疾病的支架治疗作为一种更常规的策略。然而，冠状动脉旁路手术也通过使用更多的动脉移植物、更好的围手术期护理以及术后优化药物治疗而得到改善。支架技术的进步可能会进一步缩小冠状动脉手术和PCI之间的差距，但需要左主干血运重建有效性的Xience Prime与冠状动脉旁路手术评估研究的结果，该研究将左主干冠状动脉疾病患者随机分为冠状动脉旁路移植术和PCI组，以测试PCI是否不劣于冠状动脉旁路手术。
