双导丝球囊治疗冠状动脉分叉病变的影响因素
Influential factors of efficacy of dual-wire balloon in coronary bifurcation lesions

吴铮,柳景华,朱小玲,王健,赵东晖,李世英.双导丝球囊治疗冠状动脉分叉病变的影响因素[J].内科急危重症杂志,2016,22(3):

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英文关键词:Dual-wire balloon Bifurcation lesion Plaque shift Coronary artery disease

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作者	单位	E-mail
吴铮	首都医科大学附属北京安贞医院	wysbss82@126.com
柳景华	首都医科大学附属北京安贞医院北京市心肺血管疾病研究所北京 100029
朱小玲	首都医科大学附属北京安贞医院北京市心肺血管疾病研究所北京 100029
王健	首都医科大学附属北京安贞医院北京市心肺血管疾病研究所北京 100029
赵东晖	首都医科大学附属北京安贞医院北京市心肺血管疾病研究所北京 100029
李世英	首都医科大学附属北京安贞医院北京市心肺血管疾病研究所北京 100029

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中文摘要:

目的：此前有研究验证了双导丝球囊用于分叉病变预处理是有效的,本研究旨在进一步分析双导丝球囊治疗分叉病变中影像学效果的影响因素。方法：回顾性分析了冠状动脉分叉病变210例。分别按照主支/边支血管参考直径、主支/边支血管狭窄程度、主支和边支血管成角对边支血管即刻管径获得进行亚组分析。结果：在球囊扩张主支血管后,在绝大多数病例中,双导丝球囊组边支血管即刻管径获得的绝对值都要比普通球囊组明显要小(P≤0.05)。而在主支血管置入支架后,只有在主支血管狭窄程度最重的≥95%(?0.25mm±0.26mm vs. ?0.54mm±0.40mm,P＜0.01)、边支血管参考直径较小的2.0mm～2.5mm(?0.29mm±0.28mm vs. ?0.52mm±0.31mm,P＜0.01)、边支血管狭窄程度相对较轻的＜50%(?0.09mm±0.13mm vs. ?0.14mm±0.06mm,P=0.02)、主支和边支血管成角较小的＜70度(?0.30mm±0.35mm vs. ?0.60mm±0.37mm,P＜0.01)这部分病例中,可以观察到边支血管即刻管径获得的绝对值比普通球囊组明显要小这一现象。结论：双导丝球囊用于分叉病变预处理可以在一定程度上减轻主支血管斑块向边支血管位移的程度,特别是对于主支血管狭窄程度较重、边支血管较细、边支血管狭窄程度较轻、Y型分叉病变,即便是在主支血管置入支架后仍然可以观察到双导丝球囊预处理分叉病变后的获益。

英文摘要:

Objective：Several studies had confirmed the efficacy of dual-wire balloon in coronary bifurcation lesions, there will be subgroup analysis the influential factors of the efficacy. Methods：210 coronary bifurcation lesions were enrolled retrospectively. According reference diameter and stenosis of main vessel/side branch and angulation between main vessel and side branch, there was subgroup analysis of acute lumen diameter gain. Results：After predilation, in most cases, acute lumen diameter gain of dual-wire balloon was much smaller than that of ordinary balloon(P≤0.05). After stent implantation, only in the bifurcation lesions with main vessel stenosis≥95% (?0.25mm±0.26mm vs. ?0.54mm±0.40mm,P＜0.01), side branch reference diameter 2.0mm～2.5mm (?0.29mm±0.28mm vs. ?0.52mm±0.31mm,P＜0.01), side branch stenosis＜50% (?0.09mm±0.13mm vs. ?0.14mm±0.06mm,P=0.02), angulation between main vessel and side branch＜70 degree (?0.30mm±0.35mm vs. ?0.60mm±0.37mm,P＜0.01), there was significantly smaller absolute value of acute lumen diameter gain in dual-wire balloon group compared with ordinary balloon group. Conclusion： Predilation with dual-wire balloon could reduce plaque shift from main vessel to side branch, especially in the bifurcation lesions of severe stenotic main vessel, small side branch, mild stenotic side branch and Y-shape, less plaque shift could be observed in dual-wire balloon group even if after stent implantation.