边支双导丝技术在分叉病变中的边支保护作用

目的 比较在处理冠脉分叉病变时,边支内预留双导丝与传统预留单导丝在完成主支支架置入后对边支的保护作用.方法 120例冠脉分叉病变,随机分为两组：A组（60例）放置单导丝于边支内;B组（60例）放置双导丝于边支内.两组患者均采用必要性支架置入技术,在完成主支内球囊预扩张、支架置入后,比较两组间边支闭塞的发生率、边支开口狭窄明显加重的发生率及完成交换导丝的时间,边支需置入支架的情况,同时比较两组术后心肌肌钙蛋白T的变化.在6～12个月时随访冠脉造影了解边支的狭窄程度.结果 A组7例（11.6％）发生边支闭塞;B组0例发生边支闭塞（P＜0.05）;边支开口狭窄明显加重的发生率,A组36.7％（22例）,B组10％（6例）（P＜0.05）;完成交换导丝时间,A组（26.0±14.5）min,B组（15.0±11.4）min（P＜0.05）.A组中有24例（40.0％）边支置入支架,B组有5例（8.3％）边支置入支架（P＜0.05）.术后A组中有12例患者cTnT升高,平均为（0.206±0.031）ng/ml,B组中有1例cTnT升高,为0.168 ng/ml.A组有23例患者6～12个月接受了冠脉造影复查,B组有20例患者复查了冠脉造影.冠脉造影提示A组23例患者术后即刻有3例边支完全闭塞,术后随访仍有2例为完全闭塞,而在B组术后即刻及术后随访均无边支闭塞;A组边支术后即刻狭窄程度平均为（68.72±14.21）％,随访为（43.25±18.42）％,B组边支术后即刻狭窄程度平均为（52.47±12.63）％,随访示边支狭窄程度为（21.52±10.08）％,两组比较差异有统计学意义（P＜0.05）.结论 在分叉病变中,双保护导丝较传统的单导丝放入边支或重要分支,在完成冠脉分叉病变主支支架置入后可以明显减少边支的丢失,减轻边支开口狭窄程度,减少心肌损伤,保证交换导丝顺利,缩短了手术时间,提高了手术的安全性,同时也减少了边支支架的置入,降低了手术费用.

The protective effect of double wire at side branch in dealing with bifurcation lesions

Objective To evaluate the protective effect and clinical application of double guide wire at side branch in dealing with bifurcation lesion compare with conditional single guide wire at side branch.Methods 120 cases of coronary bifurcation lesions were randomly divided into two groups,group A（60 patients） were placed within a single wire to the side branch,group B （60 patients） placing double wire on the side branch.We compared the incidence of side branch occlusion,serious stenosis at the opening,the time of exchange guide wire and rate of need to implant stent at side branch after dilation and stent at main branch.Results There was no side branch occluded at group B,but 7 side branch occluded at group A.The incidence of serious stenosis was 36.7 percent （22 case） at group A compare with 10 percent（6 case） at group B.The time of exchange guide wire was （26.0±14.5）minutes at group A compare with （15.0±11.4）minutes at group B.At group A,there were 24 patients＇ side branch was deal with stent at last,but there was only 5 patients at group B （P＜0.05）.12 patients＇ cTnT elevated in group A,the average degree was （0.206±0.031）ng/ml,but only one patient＇ cTnT reached 0.168 ng/ml in group B （P＜0.05）.23 patients accepted coronary arteries radiography reexamination in group A,and 20 patients in group B,and found 3 side branch blocked completely just after operation,and 2 side branch still blocked at 6 to 12 month follow-up in group A,but there was no block in group B.The narrow degree in group A was （68.72±14.21）％,and （52.47±12.63）％ in group B just after operation.It changed to （43.25±18.42）％ in group A and （21.52±10.08）％ in goup B at 6-12 month,the difference has significance （P＜0.05）.Conclusion Double guide wire at side branch compare with single guide wire in dealing with bifurcation lesion obvious reduces side branch lost,prevention side branch opening narrow obvious increased,guarantee exchange guide wire smooth,shorten surgery time,increase safety,while also reduces stent implantment on side branch and the surgery costs.