Szabo 两支架技术治疗冠状动脉分叉病变：操作和短期结果。
Szabo 2-stent technique for coronary bifurcation lesions: procedural and short-term outcomes.
机构信息
Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Xietu Road No. 1609, Shanghai, 200032, People's Republic of China.
出版信息
BMC Cardiovasc Disord. 2020 Jul 7;20(1):325. doi: 10.1186/s12872-020-01605-y.
BACKGROUND
Provisional 1-stent technique is currently regarded as the default approach for the majority of bifurcation lesions. Nonetheless, 2-stent techniques may be required for complex bifurcations with high compromise risk or fatal consequences of side branch (SB) occlusion. Limitations exist in current approaches, as stents gap, multiple metal layers and stent malapposition caused by imprecise placement with fluoroscopic guide and intrinsic technical defects. This study was designed to investigate the effectiveness of the novel Szabo 2-stent technique for coronary bifurcation lesions.
METHODS
In the Szabo 2-stent technique, one stent is precisely implanted at the SB ostium with Szabo technique resulting in a single strut protruding into the main vessel (MV). After MV rewiring and SB guidewire withdrawal, another stent is implanted in MV followed by proximal optimization technique, SB rewiring, and final kissing inflation (FKI).
RESULTS
The technique tested successfully in silicone tubes (n = 9) with: procedure duration, 31.2 ± 6.8 min; MV and SB rewiring time, 26.8 ± 11.2 s and 33.3 ± 15 s; easy FKI; and 2.3 ± 0.5 balloons/procedure. Bifurcation lesions (n = 22) were treated with angiographic success in MV and SB, respectively: increased minimal lumen diameter (0.63 ± 0.32 mm to 3.20 ± 0.35 mm; 0.49 ± 0.37 mm to 2.67 ± 0.25 mm); low residual stenosis (12.4 ± 2.4%; 12.4 ± 2.3%); and intravascular ultrasound confirmed (n = 19) full coverage; minimal overlap and malapposition; minimal lumen area (2.4 ± 1.2 mm; 2.1 ± 1.0 mm); plaque burden (78.1 ± 11.3%; 71.6 ± 15.5%); and minimal stent area (9.1 ± 1.6 mm; 6.1 ± 1.3 mm). Periprocedural cardiac troponin increased in 1 asymptomatic patient without electrocardiographic change. There was no target lesion failure (cardiac death, myocardial infarction, target lesion revascularization) at 6-month follow-up.
CONCLUSIONS
The Szabo 2-stent technique for bifurcation lesions provided acceptable safety and efficacy at short-term follow-up.
背景
目前，对于大多数分叉病变，临时 1 支架技术被认为是首选方法。然而，对于复杂的分叉病变，或边支（SB）闭塞有高风险或致命后果时，可能需要使用 2 支架技术。目前的方法存在局限性，如支架间隙、多层金属和由于透视引导的不精确放置以及固有技术缺陷导致的支架贴壁不良。本研究旨在探讨新型 Szabo 2 支架技术治疗冠状动脉分叉病变的有效性。
方法
在 Szabo 2 支架技术中，通过 Szabo 技术将一个支架精确地植入 SB 开口处，使单个支架突入主血管（MV）。在 MV 重新布线和 SB 导丝撤出后，在 MV 中植入另一个支架，然后进行近端优化技术、SB 重新布线和最终的对吻球囊扩张（FKI）。
结果
该技术在硅胶管中成功测试（n=9），手术时间为 31.2±6.8 分钟；MV 和 SB 重新布线时间分别为 26.8±11.2 秒和 33.3±15 秒；FKI 容易进行；每例手术使用 2.3±0.5 个球囊。22 例分叉病变在 MV 和 SB 中分别进行了血管造影成功治疗：最小管腔直径增加（0.63±0.32 毫米至 3.20±0.35 毫米；0.49±0.37 毫米至 2.67±0.25 毫米）；低残余狭窄（12.4±2.4%；12.4±2.3%）；血管内超声证实（n=19）完全覆盖；最小重叠和贴壁不良；最小管腔面积（2.4±1.2 毫米；2.1±1.0 毫米）；斑块负荷（78.1±11.3%；71.6±15.5%）；最小支架面积（9.1±1.6 毫米；6.1±1.3 毫米）。1 例无症状患者的肌钙蛋白升高，但无心电图改变。在 6 个月的随访中，没有发生目标病变失败（心源性死亡、心肌梗死、靶病变血运重建）。
结论
在短期随访中，Szabo 分叉病变 2 支架技术的安全性和疗效可接受。
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