李凌月,杨英,高瑾,晁好一,张家惠,王宪沛

• 1:河南大学人民医院心内科
• 2:郑州大学华中阜外医院心内科
• 3:阜外华中心血管病医院心内科

摘要(Abstract)：

目的:评估支架-药物球囊-支架(stent-balloon-stent, SBS)技术在复杂非左主干分叉病变中的临床结局。方法:本研究回顾性纳入2021年1月—2023年12月接受PCI治疗的484例复杂非左主干分叉病变患者，根据介入策略分为SBS组(124例)、传统双支架组(SS组，103例)及主支支架分支药物球囊组(SB组，257例)。主要终点为12个月主要不良心脏事件(MACEs),次要终点包括术中并发症及术后即刻管腔效果。同时对SBS组分支处理后分支开口夹层情况及TIMI血流分级进行记录。结果:SB组术中分支急性闭塞发生率为4.3%,而SBS组及SS组均未观察到该事件，组间差异有统计学意义(P=0.007);同时，与SB组相比，SBS组及SS组主支与分支即刻残余狭窄率均显著低于SB组(均P<0.001)。12个月随访期间，各组均未发生心源性死亡，非致死性心肌梗死发生率无显著差异；SBS组靶血管血运重建发生率显著低于SS组及SB组(1.6%vs.4.9%vs.8.2%,P=0.033)。SBS组分支处理后以轻度夹层为主，且TIMI血流均维持在3级。结论:在复杂非左主干分叉病变中，SBS技术在获得良好即刻管腔效果的同时，可显著降低分支急性闭塞发生率，并在12个月随访中表现出较低的靶血管血运重建发生率，提示其在分支保护方面具有潜在优势。

关键词(KeyWords)： 冠心病;冠状动脉分叉病变;经皮冠状动脉介入治疗;支架-药物球囊-支架;双支架技术

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 李凌月,杨英,高瑾,晁好一,张家惠,王宪沛

DOI: 10.13201/j.issn.1001-1439.2026.10.006

参考文献(References)：

• [1] Hildick-Smith D,Behan MW,Lassen JF,et al.The EBC TWO study(European bifurcation coronary TWO):a randomized comparison of provisional T-stenting versus a systematic 2 stent culotte strategy in large caliber true bifurcations[J].Circ Cardiovasc Interv,2016,9(9):e003643.
• [2] Lassen JF,Albiero R,Johnson TW,et al.Treatment of coronary bifurcation lesions,part II:implanting two stents.The 16th expert consensus document of the European Bifurcation Club[J].EuroIntervention,2022,18(6):457-470.
• [3] Medina A,Suárez de Lezo J,Pan M.A new classification of coronary bifurcation lesions[J].Rev Esp Cardiol,2006,59(2):183.
• [4] Burzotta F,Lassen JF,Lefèvre T,et al.Percutaneous coronary intervention for bifurcation coronary lesions:the 15th consensus document from the European Bifurcation Club[J].EuroIntervention,2021,16(16):1307-1317.
• [5] Chen SL,Sheiban I,Xu B,et al.Impact of the complexity of bifurcation lesions treated with drug-eluting stents:the DEFINITION study(Definitions and impact of complEx biFurcation lesIons on clinical outcomes after percutaNeous coronary IntervenTIOn using drug-eluting steNts)[J].JACC Cardiovasc Interv,2014,7(11):1266-1276.
• [6] Chen SL,Ye F,Zhang JJ,et al.Randomized comparison of FFR-guided and angiography-guided provisional stenting of true coronary bifurcation lesions:the DKCRUSH-VI trial(double kissing crush versus provisional stenting technique for treatment of coronary bifurcation lesions VI)[J].JACC Cardiovasc Interv,2015,8(4):536-546.
• [7] Chen SL,Zhang JJ,Han YL,et al.Double kissing crush versus provisional stenting for left main distal bifurcation lesions:DKCRUSH-V randomized trial[J].J Am Coll Cardiol,2017,70(21):2605-2617.
• [8] Li SJ,Ge Z,Kan J,et al.Cutoff value and long-term prediction of clinical events by FFR measured immediately after implantation of a drug-eluting stent in patients with coronary artery disease:1-to 3-year results from the DKCRUSH VII registry study[J].JACC Cardiovasc Interv,2017,10(10):986-995.
• [9] Ferenc M,Neumann FJ.Towards a lesion-specific approach to percutaneous coronary intervention for bifurcation lesions[J].Eur Heart J,2020,41(27):2537-2540.
• [10] Hildick-Smith D,de Belder AJ,Cooter N,et al.Randomized trial of simple versus complex drug-eluting stenting for bifurcation lesions:the British Bifurcation Coronary Study:old,new,and evolving strategies[J].Circulation,2010,121(10):1235-1243.
• [11] 高瑾.支架-药物球囊-支架术式治疗冠状动脉左主干复杂分叉病变的临床应用疗效研究[D].河南大学，2024.
• [12] Chen SL,Ye F,Zhang JJ,et al.DK crush technique:modified treatment of bifurcation lesions in coronary artery[J].Chin Med J,2005,118(20):1746-1750.
• [13] Toth GG,Sasi V,Franco D,et al.Double-kissing culotte technique for coronary bifurcation stenting[J].EuroIntervention,2020,16(9):e724-e733.
• [14] Li DD,Dai HM,Gao CC,et al.Review of techniques for protecting side branch from occlusion during provisional stenting in coronary bifurcation lesions[J].Rev Cardiovasc Med,2023,24(11):323.
• [15] Gao XF,Tian NL,Kan J,et al.Drug-coated balloon angioplasty of the side branch during provisional stenting:the multicenter randomized DCB-BIF trial[J].J Am Coll Cardiol,2025,85(1):1-15.
• [16] Aliabadi D,Tilli FV,Bowers TR,et al.Incidence and angiographic predictors of side branch occlusion following high-pressure intracoronary stenting[J].Am J Cardiol,1997,80(8):994-997.
• [17] Hahn JY,Chun WJ,Kim JH,et al.Predictors and outcomes of side branch occlusion after main vessel stenting in coronary bifurcation lesions results from the COBIS II registry(COronary BIfurcation stenting)[J].J Am Coll Cardiol,2013,62(18):1654-1659.
• [18] Pan M,Lassen JF,Burzotta F,et al.The 17th expert consensus document of the European Bifurcation Club-techniques to preserve access to the side branch during stepwise provisional stenting[J].EuroIntervention,2023,19(1):26-36.
• [19] Kini AS,Dangas GD,Baber U,et al.Influence of final kissing balloon inflation on long-term outcomes after PCI of distal left main bifurcation lesions in the EXCEL trial[J].EuroIntervention,2020,16(3):218-224.
• [20] Holm NR,Andreasen LD,Neghabat O,et al.OCT or angiography guidance for PCI in complex bifurcation lesions[J].N Engl J Med,2023,389(16):1477-1487.
• [21] Katritsis DG,Siontis GCM,Ioannidis JPA.Double versus single stenting for coronary bifurcation lesions:a meta-analysis[J].Circ Cardiovasc Interv,2009,2(5):409-415.
• [22] Zhang Q,Huan HS,Han Y,et al.Clinical outcomes following simple or complex stenting for coronary bifurcation lesions:a meta-analysis[J].Clin Med Insights Cardiol,2022,16:11795468221116842.
• [23] Jeger RV,Eccleshall S,Wan Ahmad WA,et al.Drug-coated balloons for coronary artery disease:third report of the international DCB consensus group[J].JACC Cardiovasc Interv,2020,13(12):1391-1402.
• [24] Bhogal S,Hill AP,Merdler I,et al.Drug-coated balloons for coronary artery disease:An updated review with future perspectives[J].Cardiovasc Revasc Med,2024,69:79-89.
• [25] 曾秋棠，俞坤武.冠心病介入治疗进展[J].临床心血管病杂志，2025,41(3):176-180.
• [26] Lesiak M.The need for dedicated bifurcation stents:a critical analysis[J].Interv Cardiol,2016,11(2):124-127.
• [27] Park DW,Choi Y.Long-term outcomes of provisional strategy versus two-stent with culotte for non-left main bifurcation lesions:“less is more”?[J].EuroIntervention,2023,19(4):e277-e278.