双导丝边支保护技术在冠心病真分叉病变介入治疗中的临床应用
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淮安市应用研究和科技攻关(社会发展)计划项目(HAS2014009)


The clinical application of double wire at side-branch in dealing with true bifurcated lesions
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    摘要:

    目的:探讨双导丝边支保护技术在冠状动脉真分叉病变介入治疗中对边支的保护作用及远期影响-方法:按照随机数法将138 例冠状动脉真分叉病变患者随机分为单导丝组(n=68)和双导丝组(n=70),比较两组患者在主支血管支架置入后边支血管即刻闭塞和狭窄加重的情况-完成导丝交换的时间及边支需要植入支架的情况;9~12个月内复查冠状动脉造影观察主支血管再狭窄和边支血管闭塞发生情况-结果:双导丝组边支血管即刻闭塞率和边支开口狭窄加重情况比例-完成交换导丝时间和边支需植入支架的患者比例显著低于单导丝组(P < 0.05);9~12个月复查冠脉造影示两组间主支支架内再狭窄率无显著差异(P > 0.05),但是单导丝组边支闭塞率高于双导丝组(P < 0.05)-结论:双导丝边支保护技术在真分叉病变介入治疗中可以明显减少边支的即刻(及远期)丢失率,预防边支开口狭窄加重,减少边支需要植入支架的概率,提高了手术安全性-同时,双导丝技术可以减少远期边支血管丢失,更好改善分叉病变患者的预后-

    Abstract:

    Objective:To evaluate the protective effect and the long term clinical outcomes of double guide wire at side-branch compared with single guide wire in dealing with true bifurcated lesion. Methods:A total of 138 patients with true bifurcated lesions treated by simple stenting were enrolled and randomly divided into two groups:the single wire group (68 patients,with single wire at side-branch)and the double wire group(70 patients,with double wires at side-branch). The following acute post-stenting complications were evaluated:aggravated stenosis and instant occlusion of side-branch,time of exchanging guide wire and the rate of stenting at the side-branch. At the same time,restenosis and occlusion of main vessel and side-branch were evaluated by coronary angiograph(CAG)within 9-12 months follow-up. Results:The incidence of side-branch instant occlusion and aggravated stenosis,time of exchanging guide wire and the rate of stenting at the side-branch in the single wire group were higher than those in the double wire group (P < 0.05). There were no significant differences in the incidence of main vessel restenosis between the two groups (P > 0.05),however,the rate of side-branch occlusion in the double wire group was lower than that in the single wire group within 9-12 months follow up (P < 0.05). Conclusion:Double wire at side-branch in dealing with true bifurcated lesion significantly reduces the happening of side-branch instant (and long term)loss,prevents the aggravation of side-branch stenosis in which case stent needed and enhances the safety of surgery compared with single wire. Double wire technique may also reduce the adverse cardiac events in patients with true bifurcated lesion.

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张喜文,杨伟伟,王继鹏,马树人,严 山.双导丝边支保护技术在冠心病真分叉病变介入治疗中的临床应用[J].南京医科大学学报(自然科学版),2016,(6):742-745

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  • 收稿日期:2015-09-07
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  • 在线发布日期: 2016-06-15
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