目的：采用单支架“骑跨”术治疗左主干分叉病变，观察术前左回旋支开口最小管腔面积（MLA）和斑块负荷（PB）与其术后发生心肌缺血的相关性研究。方法对5例左主干分叉病变患者进行术前血管内超声（IVUS）检查，单支架“骑跨”术后行血流储备分数（FFR）检查，评价术前左回旋支开口MLA和PB与术后存在心肌缺血的关系。结果5例患者术前左主干平均MLA为（4.99±2.3）mm2，平均最小管腔直径（MLD）为（2.26±2.8）mm；左前降支开口及近端平均MLA为（4.01±2.0）mm2，平均PB为（68.15±10.1）％；左回旋支开口平均MLA为（4.94±0.4）mm2，平均PB为（66.00±6.0）％。对5例患者采用从左主干至前降支的单支架“骑跨”技术进行治疗后，仅1例（病例2）患者左回旋支的FFR为0.42，行双支架术治疗后，左回旋支的FFR升至0.84；其余4例患者左回旋支的FFR均大于0.75。结论整合血管内超声和血流储备分数技术，有可能获得左回旋支开口预测单支架术后发生心肌缺血的临界值。%Objective To investigate the relationship between the Minimum Lumen Area (MLA) and plaque burden(PB) of the left circumlfex (LCX) ostial and the occurrence of myocardial ischemia after a single stent crossover for the treatment of left main (LM) bifurcated lesions. Methods Intravascular ultrasound (IVUS) assessment was performed on 5 patients, each where coronary angiography showed left main bifurcated lesions, and to measure the MLA and PB of the LCX. Following a single stent crossover fractional lfow reserve (FFR) evaluation were performed in all 5 patients to investigate the relationship between the MLA and PB of the LCX ostium and the occurrence of myocardial ischemia. Results The mean MLA of the left main coronary of the 5 patients was (4.99±2.3) mm2 with the minimum lumen diameter (MLD) being (2.26±2.8) mm. The average MLA of the left anterior descending (LAD) ostial or proximal was (4.01±2.0) mm2, mean plaque burden (PB) at the LAD ostial or proximal was (68.15±10.1)%. Average MLA of LCX was (4.94±0.4) mm2 with a plaque burden of (66.00±6.0)%. Single stent crossover technique was used to treat the bifurcated lesions. Among the 5 patients, only 1 of them was treated with a double stent deployment where the LCX ostial FFR was<0.75 (FFR=0.42). The remaining 4 patients showed LCX ostial FFR of>0.75. Conclusions Integrated IVUS and FFR would achieve threshold measurements of MLA at LCX’s ostium which could predict ischemia after one stent strategy.
展开▼
