Gambhir D S, Petkar S, Trehan V, Nair M, Bhargava M, Kumar R A, Khalilullah M
Department of Cardiology, G. B. Pant Hospital, New Delhi.
Indian Heart J. 1995 Mar-Apr;47(2):115-9.
Although bifurcation lesions in the coronary arteries can be dilated with balloon angioplasty, directional atherectomy is emerging as the treatment of choice in patients with large arteries. In this study, we report the immediate results and acute complications of treating bifurcation lesions in the coronary arteries with directional atherectomy in 9 patients, ranging in age from 33 to 60 (mean 56.7 +/- 10.8) years. All patients had true bifurcation stenoses with luminal diameter narrowing of more than 70 percent in both the primary vessel and the side branch. The lesions involved the left anterior descending (LAD)-diagonal system in 5, left circumflex (LCx)-obtuse marginal (OM) in 2, distal right coronary artery (RCA) in 1 and bifurcation of a large first diagonal branch in one patient. Double-wire atherectomy technique was used in 4 patients, although 7 had an additional wire in the side branch during post-atherectomy balloon angioplasty. The procedure was successful in all patients (100%), with luminal diameter stenosis decreasing from 93 +/- 7.5 percent to 6 +/- 8.6 percent in the primary vessel and from 83 +/- 9.2 percent to 13 +/- 9 percent in the side branch. There were no major complications. Minor complications included non-flow limiting dissection in 4 patients, distal migration of thrombus in one, occlusion of 2 small distal branches of the diagonal in one and entwinement of the guidewires in one. In conclusion, directional atherectomy can be performed safely and successfully for dilatation of complex bifurcation lesions in the coronary arteries without any major complications using the double-wire or sequential atherectomy technique.
尽管冠状动脉分叉病变可用球囊血管成形术进行扩张，但定向旋切术正逐渐成为大动脉患者的首选治疗方法。在本研究中，我们报告了9例年龄在33至60岁（平均56.7±10.8岁）的患者采用定向旋切术治疗冠状动脉分叉病变的即时结果和急性并发症。所有患者均存在真性分叉狭窄，主支血管和侧支血管的管腔直径狭窄均超过70%。病变累及左前降支（LAD）-对角支系统5例，左旋支（LCx）-钝缘支（OM）2例，右冠状动脉远端（RCA）1例，以及1例大的第一对角支分叉处病变。4例患者采用双导丝旋切技术，尽管7例患者在旋切术后球囊血管成形术期间侧支血管内额外放置了一根导丝。所有患者手术均成功（100%），主支血管管腔直径狭窄从93±7.5%降至6±8.6%，侧支血管管腔直径狭窄从83±9.2%降至13±9%。无重大并发症。轻微并发症包括4例患者出现非血流限制性夹层，1例患者血栓远端迁移，1例患者对角支2个小的远端分支闭塞，1例患者导丝缠绕。总之，使用双导丝或序贯旋切技术，定向旋切术可安全、成功地用于扩张冠状动脉复杂分叉病变，且无任何重大并发症。
