双支架术式的体外模拟研究

摘要

Objective To investigate the differences of various two-stent techniques in vitro and virtual bench testing. Methods Stent implantation with classic crush, double kissing ( DK) crush and culotte stenting techniques were performed in the silicone simulation model of bifurcation vessels with various distal bifurcation angles. The whole processes were recorded by a micro-focus camera. Results Distal side branch (SB) re-crossing in classical crush technique left a significant gap without stent coverage near the carina in T type bifurcation model after final kissing balloon inflation (FKBI) . The gap was also noted in either classic crush with proximal SB re-crossing or DK crush with two times proximal SB re-crossing in T type bifurcation model. The size of the gap in DK crush technique was smaller than that of classic crush. In Y type bifurcation model, both DK crush and culotte stenting left no gap compared to T type bifurcation model. Two times proximal SB re-crossing in culotte stenting resulted in a new stent carina formation after FKBI. Conclusions Distal bifurcation angle was an anatomatic predictor of gap formation in two-stent technique. In T type bifurcation model, the size of gap in DK crush technique was smaller than that of classic crush. It was suggested to perform two times proximal SB re-crossing for DK crush technique and distal SB re-crossing for culotte stenting.%目的：研究不同双支架术式(包括经典挤压支架术、双对吻挤压支架术和裙裤支架术)在不同分叉角度的分叉血管模型中的表现。方法基于不同分叉角度的硅树脂分叉血管模型，全程使用微聚焦相机照相，观察运用不同双支架术后的支架形态学以及分支开口间隙区的差异。结果基于“T”型分叉(远端分叉角度90°)：运用经典挤压支架术，再次放置导丝从远端网眼进入分支，完成对吻扩张后，分支开口嵴侧无支架钢梁覆盖；无论是经典挤压支架术(再次放置导丝从近端网眼进入分支)，还是双对吻挤压支架术(两次放置导丝都从近端网眼进入)，分支开口嵴侧都留有间隙区，但双对吻挤压支架术后的间隙空间小于经典挤压支架术。基于“Y”型分叉(远端分叉角度﹤70°)：双对吻挤压支架术和裙裤支架术后分支开口无间隙形成；裙裤支架术若两次放置导丝都从近端网眼进入分支，术后分支开口会形成新的金属嵴。结论远端分叉角度是决定双支架术后分支开口间隙形成的重要解剖学因素。对于“T”型分叉，运用挤压支架术在分支开口嵴侧都留有间隙，但双对吻挤压支架术后的间隙空间明显小于经典挤压支架术；双对吻挤压支架术两次放置导丝都应从近端网眼进入分支；裙裤支架术两次放置导丝都应从远端网眼进入分支。