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目的观察冠状动脉分叉病变经皮冠状动脉介入治疗(PCI)后分支血管病变程度变化,探讨分叉病变PCI中较简单的边支血管处理策略可行性及临床意义。方法病例入选条件:①各类分叉病变;②主支植入支架,边支不植入支架,除非≥2 mm血管在主支PCI后发生闭塞:③分支血管开口在主支支架后受压≥50％且直径≥2 mm者则采用球囊对吻,否则不行球囊对吻:④所有患者均使用药物洗脱支架(包括CYPHER、TAXUS、FIREBIRD及PARTNER)。符合上述条件的患者98例,男性67例、女性31例,平均年龄63．3岁。对上述患者进行定期临床随访及冠状动脉造影,以QCA测量分支开口直径狭窄率(DSR)、最小血管内径(uLD),并进行TIMl分级。结果本组采用和不用球囊对吻者分别为29例(30％)和69例(70％);主支支架植入后7例(7％)发生分支血管闭塞,3例经球囊对吻后恢复TIMI3级血流,其余4例因分支血管较小未做进一步处理。6个月和12个月随访期间MACE(均为心绞痛)累计发生率分别10％和25％。PCI术前(n=98)、术后即刻(n=98)、术后6个月(n=76)和术后12个月(17=45)分支血管开口MLD分别为(1．91±0．5)、(1．3±0．6)、(1．2±0．6)和(1．4±0．6)mm;DSR分别为45．1%10．3％、66．8%±16．5％、67．2%±16．1％和67．6％±13．8％;TIMI血流分别为2．8±0．4、2．5±0．6、2．5±0．3和2．4±0．6。统计分析显示,MLD、DSR和TIMI血流分级在PCI术前与术后各随访阶段差异有统计学意义,但术后即刻与术后6个月及12个月随访时差异无统计学意义。结论分叉病变PCI时不必对边支血管尤其直径小于2 mm者采取激进的处理策略:简单处理策略可降低PCI的难度．确保主支血管PCI术顺利完成,增加治疗效果-费用比。
Objective To observe the changes of the degree of branch vessel lesions after percutaneous coronary intervention (PCI) in patients with coronary bifurcation and to explore the feasibility and clinical significance of the simpler vessel branch treatment in bifurcation lesions. Methods The cases were selected as follows: (1) all kinds of bifurcation lesions; (2) the main branch was implanted into the scaffold and the branch was not implanted into the scaffold unless the occlusion of ≥2 mm vessel occured after the main branch; (3) Balloon kissing is used for patients ≥50% and ≥2 mm in diameter, otherwise balloon kissing is not possible: ④ All patients have a drug eluting stent (including CYPHER, TAXUS, FIREBIRD and PARTNER). In line with the above conditions in 98 patients, 67 males and 31 females, with an average age of 63.3 years. Periodic clinical follow-up and coronary angiography were performed on these patients. Branch diameter stenosis rate (DSR) and minimum vessel diameter (uLD) were measured by QCA, and TIMI classification was performed. Results In this group, 29 cases (30%) and 69 cases (70%) were treated with and without balloon respectively. Branch vessel occlusion occurred in 7 cases (7%) after stent implantation and in 3 cases TIMI3 grade blood flow was restored after kissing, and the remaining 4 cases were not further processed due to the smaller branch vessels. The cumulative incidence of MACE (both angina) at 6 and 12 months of follow-up was 10% and 25%, respectively. The MLD of branch vessels immediately before PCI (n = 98), immediately after PCI (n = 98), at 6 months after PCI (n = 76) and at 12 months 0.5), (1.3 ± 0.6), (1.2 ± 0.6) and (1.4 ± 0.6) mm respectively; DSR was 45.1% 10.3%, 66 respectively. 8% ± 16.5%, 67.2% ± 16.1% and 67.6% ± 13.8% respectively; TIMI blood flow was 2.8 ± 0.4,2.5 ± 0.6,2 .5 ± 0.3 and 2.4 ± 0.6. Statistical analysis showed that there were significant differences in the classification of MLD, DSR and TIMI between the preoperative and postoperative follow-up stages of PCI, but there was no significant difference between postoperative immediate and postoperative 6 months and 12 months postoperative follow-up. Conclusions Bifurcation lesions do not have to be treated aggressively with marginal branches of less than 2 mm in diameter: a simple treatment strategy can reduce the difficulty of PCI. To ensure the successful completion of the main branch of the PCI, to increase the therapeutic effect - the cost ratio.