支架内锚定技术改善分叉病变边支球囊通过性的临床研究

发布时间：2018-05-21 11:19

本文选题：冠状动脉粥样硬化性心脏病 + 分叉　；参考：《第三军医大学》2017年硕士论文

【摘要】：背景与目的:分叉病变在经皮冠状动脉介入治疗中非常常见,然而,这类病变的治疗仍然受限于手术成功率低、血管造影再狭窄率高、临床疗效欠佳。在分叉病变的PCI治疗中,球囊对吻扩张推荐用于所有双支架策略,以优化支架位置,矫正支架变形或扭曲,减少血管造影边支(再)狭窄,和改善临床预后。而在单支架,即必要时支架植入术中,当在主支血管支架植入后血管造影显示仍有显著的边支开口病变(狭窄直径75%或TIMI3)时,球囊对吻扩张也是被推荐应用的。然而,将常规球囊再次送入受损或阻塞的边支,可能受到开口斑块或者支架钢梁的阻碍,影响其通过。我们报道了一种改进的支架内锚定技术,可以改善边支球囊的通过性,并且避免对锚定区域血管造成损伤。本研究的目的是随访评估支架内锚定技术的疗效与安全性。方法:本研究连续纳入了2012年12月至2015年3月之间入住新桥医院心血管内科的159例分叉病变患者(166处分叉病变)。支架内锚定技术作为包括使用小球囊在内的常规技术通过边支失败时的挽救性方法使用。技术成功定义为边支球囊成功通过并最终球囊对吻。随访观察患者术后的主要不良心血管事件(MACEs)发生情况及支架内血栓形成(stent thrombosis,ST)的情况。随访获得的资料采用SPSS18.0中文版进行统计学分析。结果:166处分叉病变中,常规技术对吻球囊通过成功149处(89.8%)。剩下的17处分叉病变(10.2%),球囊再次通过主支血管的支架网眼失败,因此,使用了支架内锚定技术。这17处分叉病变中,有15处(88.2%)球囊成功通过主支支架网眼,并完成最终球囊对吻扩张。166处分叉病变中的164处(98.8%)完成了最终球囊对吻扩张,单支架组成功率100%,双支架组成功率97.6%。球囊最终通过失败的2例是有严重钙化的复杂分叉病变。锚定区域血管未发现血管夹层。随访至少9个月,平均随访11个月,主要不良心血管事件发生率为8.18%,有3例肯定的支架内血栓形成。结论:支架内锚定技术是常规技术失败后的一种安全有效的挽救性措施,进一步大规模试验可对其安全性及有效性进行更准确的评价。
[Abstract]:Background & objective: bifurcation lesions are very common in percutaneous coronary intervention. However, the treatment of these diseases is still limited by the low success rate of surgery, high rate of angiographic restenosis and poor clinical efficacy. In PCI treatment of bifurcation lesions, balloon dilatation is recommended for all double stent strategies to optimize stent position, correct stent distortion or distortion, reduce angiographic collateral stenosis, and improve clinical prognosis. In the case of single stent, that is, stent implantation if necessary, balloon dilatation for anastomosis is also recommended when angiographic findings show that there is still significant lesion of the lateral branch opening (75% narrow diameter or TIMI3) after stent implantation in the main branch. However, sending the conventional balloon again into the damaged or blocked side branches may be hindered by open plaques or scaffold steel beams. We report an improved in-stent anchoring technique, which can improve the permeability of the lateral branch balloon and avoid damage to the vessels in the anchoring area. The purpose of this study was to evaluate the efficacy and safety of stent anchoring technique. Methods: a total of 159 patients with bifurcation lesions admitted to the Department of Cardiovascular Medicine of Xinqiao Hospital from December 2012 to March 2015 were enrolled in this study. The stent anchoring technique is used as a rescue method for conventional techniques, including the use of small balloon, in the event of failure of the side branch. Technical success is defined as the successful passage of the lateral branch balloon and the final balloon kiss. The incidence of major adverse cardiovascular events (MACEs) and stent thromboembolism (STS) were observed. The data obtained from the follow-up were statistically analyzed using the Chinese version of SPSS18.0. Results of the 166 bifurcation lesions, the conventional technique was applied to the successful passage of 149 anastomotic saccules. For the remaining 17 bifurcation lesions (10.2%), the balloon failed again through the stent mesh of the main branch vessel, so the in-stent anchoring technique was used. Of the 17 bifurcation lesions, 15 (88.2) the balloon successfully passed through the mesh of the main branch stent, and completed the final balloon dilatation of 164 out of 166 bifurcation lesions.) the final balloon dilatation was completed. The success rate of single stent group was 100, and that of double stent group was 97.6 points. The two cases of successful balloon failure were complicated bifurcation lesions with severe calcification. No vascular dissection was found in the Anchorage area. The mean follow-up was 11 months. The incidence of major adverse cardiovascular events was 8.18. There were 3 cases of definite stent thrombosis. Conclusion: the stenting technique is a safe and effective rescue measure after the failure of conventional technology. Further large-scale test can evaluate its safety and effectiveness more accurately.
【学位授予单位】：第三军医大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R54

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