右冠脉分叉.ppt

Louvard Y, Lefevre T, Morice MC, et al, Heart 2004; 90: 713-22 Classic T beginning SB Modified T Crush Classic T beginning MB Provision T Cullotte Touching stents Trouser legs and seat Kissing stents Skirt technique Colombo et al (Circ 2004) Pan et al (AHJ 2004) Nordic (Circ 2006) n=91 n=413 n=85 6 month n=91 6 month n=413 6 month 19.0% 3.4% 10.6% 13.6% 2.9% 1.9% 6.3% 9.0% 4.5% 2.1% 1.9% 11.4% 11.1% 9.0% 1.9% 9.5% 4.5% 1.0% % of Patients MACE TVR TLR 2 Stents 1Stent 2 Stents 1Stent 2 Stents 1Stent Colombo et al (Circ 2004) Pan et al (AHJ 2004) Nordic (Circ 2006) n=91 n=413 n=85 6 month n=91 6 month n=413 6 month % of Bifurcations Bifurcation Main Branch Side Branch 18.7% 4.8% 14.2% 28.0% 5.7% 21.8% 7.0% 2.0% 5.0% 20.0% 15.0% 5.0% 4.6% 5.1% 22.5% 19.2% 16.0% 11.5% 2 Stents 1Stent 2 Stents 1Stent 2 Stents 1Stent If the side branch is significantly diseased at its ostium or nearby, it is sufficiently large to be stented, safety and duration of PCI are an issue: 2 stents In all other conditions 1 stents and then evaluate At present time the most accepted and applied strategy is provisional SB stenting Kissing Ballon No Kissing Main Branch Side Branch Crush stent T Stent Crush stent T Stent Crush stent T Stent Crush stent T Stent Crush stent T Stent Crush stent T Stent Crush stent T Stent Crush stent T Stent Restenosis (%) Lateloss (mm) 0 0.2 0.4 0.6 0.8 13.8% (8/58) 14.7% (5/34) 19.5% (8/41) 8.3% (1/12) P= NS 0.40 0.37 0.44 0.46 8.6% (5/58) 26.5% (9/34) 34.1% (14/41) 33.3% (4/12) P=0.04 P=0.003 0.23 0.37 0.71 0.44 P=0.02 P0.001 P=0.03 0 10 20 30 40 50 Ge L, et al. Heart,2006;92:371-376 Kissing Ballon No Kissing 0.6 0.4 0.2 Main Branch Side Branch 0 5 10 15 20 25 30 35 40 15.5% (9/58) 8.9% (8/90) 37.9% (22/58) 11.1% (10/90) 0.21 0.34 P = 0.10 P 0.05 P = 0.33 P 0.001 Restenosis (%) Late loss(mm) 0.32 0.52 Ge L, et al. JACC,2005;46:613-620. No kissing Kissing