Suárez de Lezo Javier, Martín Pedro, Pan Manuel, Ojeda Soledad, Nóvoa José, Segura José, Mazuelos Francisco, Romero Miguel, Medina Alfonso, Suárez de Lezo José
Servicio de Cardiología, Hospital Universitario Reina Sofía de Córdoba, Instituto Maimonides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain.
Servicio de Cardiología, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Las Palmas, Spain.
Rev Esp Cardiol (Engl Ed). 2016 Jun;69(6):554-62. doi: 10.1016/j.rec.2015.12.004. Epub 2016 Mar 3.
The treatment of coronary lesions with a bioresorbable vascular scaffold has been shown to be effective. However there is little information about its use in bifurcations. The aim of this study was to analyze the safety and efficacy of the bioresorbable scaffold in the treatment of coronary bifurcation lesions.
From January 2012 to January 2015, we used a bioresorbable vascular scaffold to treat 194 patients with 230 bifurcation lesions. The scaffold geometry was examined by intracoronary imaging techniques in 145 bifurcations (65%). In all, 78% of the bifurcations were evaluated angiographically during follow-up (computed tomography angiography in 138 and coronary angiography in 41).
The most common clinical presentation was acute coronary syndrome (81%). The most frequent type of bifurcation was 1,1,1 (34%). A simple approach was the chosen strategy in 221 bifurcations (96%). In 90 of these lesions, the side branch was postdilated through the cells of the platform and, in 3 cases, strut fractures were observed in optical coherence tomography. Procedural success was achieved in all patients. There was 1 case of subacute thrombosis and 1 sudden cardiac death during the first month. The duration of angiographic follow-up was 7.3±1.6 months and that of clinical follow-up, 14±6 months. Twelve (5%) restenoses were documented and revascularized. During follow-up, 2 patients (1%) had an infarction in another territory and another 2 patients (1%) died; the remaining patients had a symptom-free follow-up. The incidence of thrombosis was 1.3%.
Treatment of bifurcation coronary lesions using a provisional approach is feasible and safe, with a low rate of adverse events.
生物可吸收血管支架治疗冠状动脉病变已被证明是有效的。然而，关于其在分叉病变中的应用信息较少。本研究的目的是分析生物可吸收支架治疗冠状动脉分叉病变的安全性和有效性。
2012年1月至2015年1月，我们使用生物可吸收血管支架治疗了194例患者的230处分叉病变。145处（65%）分叉病变通过冠状动脉内成像技术检查支架几何形状。总共78%的分叉病变在随访期间进行了血管造影评估（138例采用计算机断层扫描血管造影，41例采用冠状动脉造影）。
最常见的临床表现是急性冠状动脉综合征（81%）。最常见的分叉类型是1,1,1型（34%）。221处（96%）分叉病变采用简单方法作为治疗策略。在其中90处病变中，通过平台细胞对侧支进行了后扩张，3例在光学相干断层扫描中观察到支架小梁骨折。所有患者均获得手术成功。第一个月内发生1例亚急性血栓形成和1例心源性猝死。血管造影随访时间为7.3±1.6个月，临床随访时间为14±6个月。记录到12例（5%）再狭窄并进行了血运重建。随访期间，2例患者（1%）在其他区域发生梗死，另外2例患者（1%）死亡；其余患者随访期间无症状。血栓形成发生率为1.3%。
采用临时方法治疗冠状动脉分叉病变是可行且安全的，不良事件发生率较低。
