复杂冠脉分叉病变的PCI治疗策略.pptVIP

PCI Strategies for Complex Coronary Bifurcation lesions 首都医科大学附属北京安贞医院 周玉杰 聂斌 Beijing Anzhen Hospital One or two stents? Nordic Bifurcation Study (n=413)413 pts with bifurcation lesion Stenting of the main vessel and side branch (MV+SB)Stenting of the main vessel and optional stenting of the side branch (MV)n=206n=207RandomizedPrimary Endpoint: Major adverse cardiac event (MACE) at 6 months Primary Endpoint of MACE at 6 months (%)p=NSPresented at ACC 2006There was no difference in major adverse cardiac events at 6 months (17.7% vs 12.7%; p=NS)Nordic Bifurcation Study (n=413) Procedure related MI was defined as a five-fold elevation of biochemical markersProcedure related MI occurred more than three times as often in the MV+SB group (13% vs 4%; p=0.008)Procedure Related Myocardial Infarction (%)p=0.008Presented at ACC 2006Nordic Bifurcation Study (n=413) One Stent StrategyProvisional T Stenting Provisional T Stent Provision-T stent technique53 pts, SB2mmMACE 9.4% at 14+/-3 monthsTLR 3.8%, MV restensosis 3.2%, SB 12.9% at 6 monthsVigna C, et al. J Invasive Cardiol. 2007 Mar;19(3):92-7. The SB has a narrowing at its ostium The MB has severe stenosis with a large plaqueburden and the SB originates with an angle of 45° The ostium of the SB deteriorates after pre-dilatation of the MBA wire is needed in the following circumstances:Provisional T Stent FKB is Very Important for Provisional T StentProvisional T Stent Two Stents TechniquesT stentCulotte SKS V stentProvisional TModified T stentY stentBMS EraDES Era Crush Reverse Crush Balloon Crush DK Crush Mini-Crush Inverted Crush T stent Technique Culotte Technique Clinical Outcomes In BMS era, the incidence of TLR was 24% at 6 months (Chevalier. Am J Cardiol 1998;82:943) In DES era, the incidence of MACE was 5.3% and TLR was 15.4% (Hoye, et al. Int J Cardiovasc interven 2005;7:36) Culotte vs T stent in