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目的探讨应用改良Crush技术置入双国产药物洗脱支架(DES)处理左主干Ⅳ型分叉病变的安全性和临床疗效。方法应用改良Crush技术处理患者左主干Ⅳ型分叉病变29例。即在左主干及分支中置入药物洗脱支架,主支支架部分压住分支支架2~3mm,并行对吻扩张。记录手术操作及住院相关资料,定量冠状动脉造影记录术前、术后及随访时冠状动脉资料。结果所有病例均以改良Crush术式完成国产DES置入术,并全部完成最终对吻扩张。平均操作时间36·2±9·4min,平均透视时间为18·3±3·5min。其中13例经桡动脉路径完成,16例经股动脉完成;17例(58·6%)患者为前降支开口病变,12例(44·8%)行球囊预扩张;23例置入PARTNER支架,6例置入EXCEL支架;主支支架直径为3·76±0·25mm,长度为18·19±3·40mm。本组病例无严重介入相关并发症发生。平均临床随访时间为14·2±5·2个月,无猝死、非致死性心肌梗死发生,无再狭窄及靶病变血运重建。14例(48·3%)进行冠状动脉造影随访,平均随访时间为11·5±2·7个月。定量冠状动脉造影显示基线开口狭窄率为78·4%,平均靶病变长度为13·20±4·71mm,主支支架即刻获得管腔为1·92±0·22mm,晚期管腔丢失为0·06±0·10mm,无主支支架再狭窄发生;边支晚期管腔丢失为0·21±0·12mm,无再狭窄发生;左主干晚期管腔丢失为0·09±0·12mm。结论Crush技术置入双国产DES处理左主干Ⅳ型分叉病变手术成功率高,具有很好的安全性和临床远期疗效。
Objective To investigate the safety and clinical efficacy of modified Crush technique in the treatment of left main type Ⅳ bifurcation lesions by double drug-eluting stent (DES). Methods Modified Crush technique was used to treat 29 cases of type Ⅳ bifurcation in the left main trunk of patients. In the left main branch and branch into the drug-eluting stent, the main stent stent partially support the branch stent 2 ~ 3mm, parallel kiss expansion. The surgical operation and hospital-related data were recorded. Coronary angiography was used to record the coronary arteries before, during and after follow-up. Results All patients underwent modified Crush surgery to complete the domestic DES implantation, and all completed the final kiss expansion. The average operation time was 36.2 ± 9.4min and the mean fluoroscopy time was 18.3 ± 3.5min. Among them, 13 cases were transradialized and 16 cases were completed via the femoral artery. Seventeen patients (58.6%) had open anterior descending branches, 12 (44.8%) pre-dilated balloons and 23 PARTNER stent, 6 cases were placed in the EXCEL stent; the main stent diameter of 3.76 ± 0.25mm, length of 18.19 ± 3.40mm. No serious complications related to this group of patients with complications. The average clinical follow-up time was 14.2 ± 5.2 months, with no sudden death, non-fatal myocardial infarction, no restenosis and target revascularization. Fourteen patients (48.3%) were followed up by coronary angiography. The mean follow-up time was 11.5 ± 2.7 months. Quantitative coronary angiography showed that the baseline stenosis rate was 78.4% and the average length of target lesion was 13.20 ± 4.71mm. The immediate lumen of the main stent was 1.92 ± 0.22mm, and the late lumen loss was 0 · There was no restenosis in the main stent at 06 ± 0 · 10 mm. The loss of late lumen was 0 · 21 ± 0 · 12 mm without restenosis. The loss of late left main lumen was 0 · 09 ± 0 · 12 mm. Conclusion Crush technique into the dual DES treatment of left main type Ⅳ bifurcation success rate is high, with good safety and long-term clinical efficacy.