本文選題：冠狀動(dòng)脈粥樣硬化性心臟病 + 分叉�。� 參考：《第三軍醫(yī)大學(xué)》2017年碩士論文

【摘要】：背景與目的:分叉病變?cè)诮?jīng)皮冠狀動(dòng)脈介入治療中非常常見,然而,這類病變的治療仍然受限于手術(shù)成功率低、血管造影再狹窄率高、臨床療效欠佳。在分叉病變的PCI治療中,球囊對(duì)吻擴(kuò)張推薦用于所有雙支架策略,以優(yōu)化支架位置,矯正支架變形或扭曲,減少血管造影邊支(再)狹窄,和改善臨床預(yù)后。而在單支架,即必要時(shí)支架植入術(shù)中,當(dāng)在主支血管支架植入后血管造影顯示仍有顯著的邊支開口病變(狹窄直徑75%或TIMI3)時(shí),球囊對(duì)吻擴(kuò)張也是被推薦應(yīng)用的。然而,將常規(guī)球囊再次送入受損或阻塞的邊支,可能受到開口斑塊或者支架鋼梁的阻礙,影響其通過。我們報(bào)道了一種改進(jìn)的支架內(nèi)錨定技術(shù),可以改善邊支球囊的通過性,并且避免對(duì)錨定區(qū)域血管造成損傷。本研究的目的是隨訪評(píng)估支架內(nèi)錨定技術(shù)的療效與安全性。方法:本研究連續(xù)納入了2012年12月至2015年3月之間入住新橋醫(yī)院心血管內(nèi)科的159例分叉病變患者(166處分叉病變)。支架內(nèi)錨定技術(shù)作為包括使用小球囊在內(nèi)的常規(guī)技術(shù)通過邊支失敗時(shí)的挽救性方法使用。技術(shù)成功定義為邊支球囊成功通過并最終球囊對(duì)吻。隨訪觀察患者術(shù)后的主要不良心血管事件(MACEs)發(fā)生情況及支架內(nèi)血栓形成(stent thrombosis,ST)的情況。隨訪獲得的資料采用SPSS18.0中文版進(jìn)行統(tǒng)計(jì)學(xué)分析。結(jié)果:166處分叉病變中,常規(guī)技術(shù)對(duì)吻球囊通過成功149處(89.8%)。剩下的17處分叉病變(10.2%),球囊再次通過主支血管的支架網(wǎng)眼失敗,因此,使用了支架內(nèi)錨定技術(shù)。這17處分叉病變中,有15處(88.2%)球囊成功通過主支支架網(wǎng)眼,并完成最終球囊對(duì)吻擴(kuò)張。166處分叉病變中的164處(98.8%)完成了最終球囊對(duì)吻擴(kuò)張,單支架組成功率100%,雙支架組成功率97.6%。球囊最終通過失敗的2例是有嚴(yán)重鈣化的復(fù)雜分叉病變。錨定區(qū)域血管未發(fā)現(xiàn)血管夾層。隨訪至少9個(gè)月,平均隨訪11個(gè)月,主要不良心血管事件發(fā)生率為8.18%,有3例肯定的支架內(nèi)血栓形成。結(jié)論:支架內(nèi)錨定技術(shù)是常規(guī)技術(shù)失敗后的一種安全有效的挽救性措施,進(jìn)一步大規(guī)模試驗(yàn)可對(duì)其安全性及有效性進(jìn)行更準(zhǔn)確的評(píng)價(jià)。
[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.
【學(xué)位授予單位】：第三軍醫(yī)大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R54

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本文編號(hào)：1918988