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1、PCIStrategiesforComplexCoronaryBifurcationlesions首都醫(yī)科大學附屬北京安貞醫(yī)院周玉杰聶斌BeijingAnzhenHospitalOneortwostents?NordicBifurcationStudy(n=413)413ptswithbifurcationlesionStentingofthemainvesselandsidebranch(MV+SB)Stentingofthemainvesselandoptionalstentingofthesidebranch(MV)n=
2、206n=207RandomizedPrimaryEndpoint:Majoradversecardiacevent(MACE)at6monthsPrimaryEndpointofMACEat6months(%)p=NSPresentedatACC2006Therewasnodifferenceinmajoradversecardiaceventsat6months(17.7%vs12.7%;p=NS)NordicBifurcationStudy(n=413)ProcedurerelatedMIwasdefinedasafiv
3、e-foldelevationofbiochemicalmarkersProcedurerelatedMIoccurredmorethanthreetimesasoftenintheMV+SBgroup(13%vs4%;p=0.008)ProcedureRelatedMyocardialInfarction(%)p=0.008PresentedatACC2006NordicBifurcationStudy(n=413)OneStentStrategyProvisionalTStentingProvisionalTStentPr
4、ovision-Tstenttechnique53pts,SB>2mmMACE9.4%at14+/-3monthsTLR3.8%,MVrestensosis3.2%,SB12.9%at6monthsVignaC,etal.JInvasiveCardiol.2007Mar;19(3):92-7.TheSBhasanarrowingatitsostiumTheMBhasseverestenosiswithalargeplaqueburdenandtheSBoriginateswithanangleof45°Theostiumoft
5、heSBdeterioratesafterpre-dilatationoftheMBAwireisneededinthefollowingcircumstances:ProvisionalTStentFKBisVeryImportantforProvisionalTStentProvisionalTStentTwoStentsTechniquesTstentCulotteSKSVstentProvisionalTModifiedTstentYstentBMSEraDESEraCrushReverseCrushBalloonCr
6、ushDKCrushMini-CrushInvertedCrushTstentTechniqueCulotteTechniqueClinicalOutcomesInBMSera,theincidenceofTLRwas24%at6months(Chevalier.AmJCardiol1998;82:943)InDESera,theincidenceofMACEwas5.3%andTLRwas15.4%(Hoye,etal.IntJCardiovascinterven2005;7:36)CulottevsTstentinDESe
7、ra80patientswithbifurcationlesionsCulottetechnique45casesTstent35casesTheproceduralsuccessrate100%TLR:8.9%P=0.014;9monthsMACE13.3%P=0.051KaplanS,etal.AmHeartJ.2007Aug;154(2):336-43Theproceduralsuccessrate100%TLR:27.3%9monthsMACE27.3%SKSTechniqueClinicalOutcome200pat
8、ientswithbifurcationlesionsSKStechniqueCypherstentsTheclinicalsuccessrateis97%TheincidenceofTLR:4%9+/-2monthsSharmaSK.CatheterizationandCa
