Gambhir D S, Sudha R, Trehan V, Singh S, Arora R, Khanna S K
Department of Cardiology, GB Pant Hospital, New Delhi.
Indian Heart J. 1996 Jul-Aug;48(4):389-94, 430.
Strategies for dilatation of bifurcation stenoses have continued to evolve over the past several years. However, there is limited experience on the efficacy of various nonballoon interventional devices and their results in comparison with balloon angioplasty. We, therefore, analysed our data in 72 patients of coronary artery disease with true bifurcation stenoses with balloon angioplasty or new device interventions (NDI). All patients underwent dilatation of both the primary vessel and side branch ostial stenosis. Balloon angioplasty using double guidewire with sequential or simultaneous (kissing balloon) balloon inflation in the two vessels was performed in 42 patients. Thirty patients underwent NDI, using directional coronary atherectomy (DCA) in 12, rotablation in 6 and elective coronary stents in 12 patients. There were no significant differences in the baseline clinical and angiographic variables between patients in the two groups. While the preprocedural luminal diameter stenosis was similar, the residual stenosis was significantly less, both in the primary vessel and side branch, after NDI compared to balloon angioplasty. The procedure was successful in 96.6 percent patients treated with NDI and 83.3 percent with balloon angioplasty (p < 0.01) with relief of obstruction in both branches without any major complications. Freedom from subsequent coronary events in the form of angina, myocardial infarction, PTCA, bypass graft surgery of death was significantly more, both at 6 months (92% versus 65.6%, p < 0.001) and 12 months (81.8% versus 53.1%, p < 0.001) in the group of patients treated with NDI compared to balloon angioplasty. It is, therefore, concluded that NDI including DCA, rotablation and elective stenting are associated with higher rate of success, lesser complications and better event-free survival in comparison to balloon angioplasty for treatment of true bifurcation stenoses.
在过去几年中，分叉病变狭窄扩张策略不断发展。然而，与球囊血管成形术相比，各种非球囊介入装置的疗效及其结果的经验有限。因此，我们分析了72例患有真性分叉病变狭窄的冠心病患者接受球囊血管成形术或新装置介入治疗（NDI）的数据。所有患者均对主要血管和分支开口狭窄进行了扩张。42例患者采用双导丝球囊血管成形术，在两根血管中顺序或同时（亲吻球囊）进行球囊扩张。30例患者接受了NDI，其中12例采用定向冠状动脉斑块旋切术（DCA），6例采用旋磨术，12例采用选择性冠状动脉支架置入术。两组患者的基线临床和血管造影变量无显著差异。虽然术前管腔直径狭窄相似，但与球囊血管成形术相比，NDI术后主要血管和分支的残余狭窄明显更小。NDI治疗的患者中有96.6%手术成功，球囊血管成形术治疗的患者中有83.3%手术成功（p<0.01），两个分支的梗阻均得到缓解，且无任何重大并发症。与球囊血管成形术相比，NDI治疗组在6个月（92%对65.6%，p<0.001）和12个月（81.8%对53.1%，p<0.001）时，以心绞痛、心肌梗死、经皮冠状动脉腔内血管成形术（PTCA）、搭桥手术或死亡形式出现的后续冠状动脉事件的无事件发生率显著更高。因此，得出结论，与球囊血管成形术治疗真性分叉病变狭窄相比，包括DCA、旋磨术和选择性支架置入术在内的NDI具有更高的成功率、更少的并发症和更好的无事件生存率。
