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1、应用Partner支架完成Crush技术治疗冠脉分叉病变的即刻及近 期随访结果,沧州市中心医院 徐泽升,背景,2005年Partner支架上市2008年全国21个心脏中心1352名患者的临床研究,背景,糖尿病患者占23.3%急性冠状动脉综合征的患者占90.49%C型病变占30.98%分叉病变占11.13%慢性完全闭塞病变占7.81%,背景,1年累积心源性死亡0.52%心肌梗死0.96%靶血管重建2.14%MACE 3.62%1年累积血栓发生率0.166%,背景,该研究208（11.13%）处分叉病变分叉病变分型、术式、结果？,目的,评价国产Partner支架在“真分叉”病变应用Crush技术治
2、疗的即可及近期近期疗效,“真分叉”病变,A new classification of coronary bifurcation lesionsMedina A,Surez de Lezo J,Pan M.Rev Esp Cardiol.2006 Feb;59(2):183.Spanish.No abstract available,Crush技术,Modified T-stenting technique with crushing for bifurcation lesions:immediate results and 30-day outcome.Colombo A,Stankovic
3、 G,Orlic D,Corvaja N,Liistro F,Airoldi F,Chieffo A,Spanos V,Montorfano M,Di Mario C.Catheter Cardiovasc Interv.2003 Oct;60(2):145-51.,入选标准,经桡A造影证实为冠状动脉真性分叉病变主支&分支狭窄大于75%主支血管直径大于2.75 mm分支血管直径大于2.5 mm 均有心肌缺血的临床症状,排除标准,急性心肌梗死primary PCI 不能接受抗血小板及强化抗凝治疗主支、分支血管直径小于2.5mm主支血管直径大于5.0mm,手术成功指标,支架置入即刻成功：指支架完全
4、覆盖靶病变并充分扩张至残余狭窄 20%。随访治疗成功：指随访时造影提示血流TIM I 3级且残余管腔狭窄小于30%,随访,随访:门诊随访或电话随访的方式，查询并记录主要终点事件的发生情况主要终点:主要不良心脏事件(MACE，包括心源性死亡、非致死性心肌梗死和靶血管再次血运重建)发生率,Baseline characteristics,Baseline characteristics,Baseline characteristics,Procedural findings,Type of crush,Procedural findings,Procedural findings,Final ki
5、ssing technique,Final kissing technique,In-hospital outcomes,Follow-up results,讨论,即刻手术成功率达100%5.42.1月MACE发生率分别为3.3%心源性死亡0%非致死性心肌梗死0%,讨论,Partner西罗莫司洗脱支架是我国自主创新设计 的一种支架，支架平台采用双螺旋结构，使得整个支架系统具有较好的支撑力和贴壁性能。在Partner西罗莫司洗脱支架,西罗莫司120g/cm2装载在多PBMA/PEVA聚合物涂层上，外表再覆盖一层表面涂层(top coating)以控制药物释放速度。,讨论,高压扩张15.40.65
6、 atm非顺应性球囊的应用58.1%Final kissing的完成96.8%,Case-1,男性，79岁3年前AMI，急诊PCI，RCA置入支架2枚6个月前不稳定心绞痛,Case1(pre-PCI),Case1(post-PCI),LCX 2.7536 Partner,LM to LAD 3.524+3.036 Parter,Case1(7 months follow up),Case-2 LCX os restenosis,2001年LAD支架（CYPHER）术后1年心绞痛再发2009年4月LM Crush（Partner），术后4个心绞痛再发2009年9月LCX os PTCA+RCA
7、os Stent脑梗死后遗症+糖尿病,Case-2,2001,LAD,Cypher,Case-2,LCX 2.524&2.529 Partner,LM to LAD 3.024 Partner,Case-2(5 months follow up),Final kissing（3.015&2.515）,Case-2,Case-2,RCA os 3.015 partner,Case-3,男性 59岁突发心前区疼痛7小时高血压病史20年糖尿病史11年,First:CRUSH,LAD2.7524&D2 2.512 Partner,Second:CRUSH,LM to LAD 3.524 Rumas 2
8、.536 Partner BMW in LCX,研究不足,样本量小随访时间短缺少双盲、对比研究,结论,本临床研究初步证实，Partner支架在实际临床中治疗真是安分叉病变安全、有效。相对低的费用使国产西罗莫司洗脱支架Partner在国内的临床复杂病变更具有吸引力。,Thanks for your attention!,THANK YOU!,Partner stents for crush technique in coronary bifurcation:immediate and short-time follow-up results,Cang Zhou Central Hosipital
9、Xu Ze-sheng,Background,In 2005,Partner stents have been on the market.In 2008,clinical study involving 1352 patients in 21 cardiovascular centers,Background,Diabetes mellitus 23.3%Acute coronary syndrome 90.49%C-type lesion 30.98%Bifurcation lesion 11.13%Chronic total ccculusion 7.81%,Background,1 y
10、ear accumulative cardiovascular mortality 0.52%Coronary infarction 0.96%Target vessel reconstruction 2.14%MACE 3.62%1 year accumulative thrombosis rate 0.166%,Background,The study include 208(11.13%)Bifurcation lesionsTypes of bifurcation lesions,procedure method？,Objective,To observe the immediate
11、and follow-up results of home-made Partner stents for crush technique in true bifurcation lesions.,Inclusion Criteria,True bifurcation lesions confirmed by transradial artery angiographyStenosis 75%in main artery&branch arteriesMain artery diameter 2.75 mmbranch arteries diameter over 2.5 mm Symptom
12、s of myocardial ischemia,Exclusion Criteria,Primary PCI for AMICannot be treated with anti-platelet or intensive anticoagulant therapy Branch arteries diameter 2.5mmMain artery diameter 5.0mm,Methods,Follow up:outpatient follow-up or telephone follow-up，record main primary endpoint eventsPrimary end
13、point:main adverse coronary event(MACE:cardiovascular death、non-fatal coronary infarction and target vessel revescularization)rates,Criteria for success,immediate success:stents completely covering target lesions and residual stenosis 20%after sufficient expansion。follow-up success:TIMI Grade 3 when
14、 follow-up and residual stenosis 30%,Discussion,Partner sirolimus-eluting stent is a new type domestic stent,DOUBLE-HELIX stent structure is engineered for outstanding flexibility and conformability.Sirolimus is loaded 120g/cm2 in PBMA/PEVA compatible coating，and another top coating to control drug
15、release.,Discussion,Immediate success rate 100%MACE rate 3.3%in(5.42.1)monthsCardiovascular mortality 0%Non-fatal coronary infarction 0%,Discussion,Expand with high pressure to 15.40.65 atmApplication of non-compliance balloon 58.1%Final kissing rate 96.8%,Case-2 LCX os restenosis,In 2001,angina rec
16、ur 1 year after procedure with LAD stent（CYPHER）In April,2009,angina recur 4 months after procedure with LM Crush（Partner）In September,2009,LCX os PTCA+RCA os StentCerebral infarction sequelea plus DM,Case-3,Male,59 years oldSudden chest pain for7 hours Hypertension for 20 yearsDM for 11 years,Limit
17、ations,Small scaleShort follow-up periodCompare with foreign products,Conclusions,Our study preliminarily confirmed the safety and efficiency of Partner stents in clinical practice of treating true bifurcation lesions.Relatively lower cost makes domestic sirolimus-eluting stent Partner attractive in clinical use of complex lesions.,
