左主干病变的评估手段及治疗研究进展
Progress in the Evaluation and Treatment of Left Main Disease
DOI: 10.12677/ACM.2022.1281066, PDF,   
作者: 冀慎利:济宁医学院临床医学院,山东 济宁;甘立军*:济宁医学院附属医院,山东 济宁
关键词: 左主干病变冠状动脉内成像经皮冠状动脉介入治疗术Left Main Coronary Artery Intracoronary Imaging Percutaneous Coronary Intervention
摘要: 左主干病变(Left main coronary artery, LMCA)是指冠状动脉左主干直径狭窄大于50%的病变。作为冠状动脉病变中死亡率最高的疾病,LMCA一直是冠状动脉疾病治疗中的重点与难点。长期以来,冠状动脉旁路移植术(Coronary artery bypass graft, CABG)是治疗左主干病变的首选方案。近年来,随着冠脉内成像技术的进步,经皮冠状动脉介入治疗术(Percutaneous coronary intervention, PCI)在左主干病变的治疗中占据一席之地。本文就国内外在左主干病变评估及治疗方面取得的进展做一综述。
Abstract: Left main coronary artery (LMCA) was defined as a coronary artery with a stenosis greater than 50% in diameter. As the disease with the highest mortality rate in coronary artery disease, LMCA has always been the focus and difficulty in the treatment of coronary artery disease. Coronary artery bypass graft (CABG) has long been the first choice for the treatment of left main artery disease. In recent years, with the development of coronary imaging technology, percutaneous coronary inter-vention (PCI) occupies a place in the treatment of left main artery disease. This article reviews the progress in the evaluation and treatment of left main disease.
文章引用:冀慎利, 甘立军. 左主干病变的评估手段及治疗研究进展[J]. 临床医学进展, 2022, 12(8): 7385-7392. https://doi.org/10.12677/ACM.2022.1281066

参考文献

[1] Li, J., Patel, S.M., Parikh, M.A., et al. (2016) Unprotected Left Main Disease: Indications and Optimal Strategies for Percutaneous Intervention. Current Treatment Options in Cardiovascular Medicine, 18, 19. [Google Scholar] [CrossRef] [PubMed]
[2] D’Angelo, C., Zagnoni, S., Gallo, P., et al. (2018) Electrocardio-graphic Changes in Patients with Acute Myocardial Infarction Caused by Left Main Trunk Occlusion. Journal of Cardi-ovascular Medicine (Hagerstown), 19, 439-445. [Google Scholar] [CrossRef
[3] Chatterjee, A., Leesar, M.A. and Hillegass, W.B. (2019) In-travascular Ultrasound of Normal Left Main Arteries: Insights for Stent Optimization and Standardization. Catheteriza-tion and Cardiovascular Interventions, 93, 239-240. [Google Scholar] [CrossRef] [PubMed]
[4] Medrano-Gracia, P., Ormiston, J., Webster, M., et al. (2016) A Computa-tional Atlas of Normal Coronary Artery Anatomy. EuroIntervention, 12, 845-854. [Google Scholar] [CrossRef
[5] Dodge, J.J., Brown, B.G., Bolson, E.L., et al. (1992) Lumen Diameter of Normal Human Coronary Arteries. Influence of Age, Sex, Anatomic Variation, and Left Ventricular Hypertrophy or Dilation. Circulation, 86, 232-246. [Google Scholar] [CrossRef
[6] Pereira, D.C., Dantas, D.L., Silva, P.R., et al. (2019) Anatomical Study of Length and Branching Pattern of Main Trunk of the Left Coronary Artery. Morphologie, 103, 17-23. [Google Scholar] [CrossRef] [PubMed]
[7] Burzotta, F., Lassen, J.F., Banning, A.P., et al. (2018) Percuta-neous Coronary Intervention in Left Main Coronary Artery Disease: The 13th Consensus Document from the European Bifurcation Club. Euro Intervention, 14, 112-120. [Google Scholar] [CrossRef
[8] Lee, C.H. and Hur, S.H. (2019) Optimization of Percutaneous Coro-nary Intervention Using Optical Coherence Tomography. Korean Circulation Journal, 49, 771-793. [Google Scholar] [CrossRef] [PubMed]
[9] 张晓萍, 马琳, 周桂玲, 等. 经皮冠状动脉介入术治疗老年冠心病的预后及其影响因素[J]. 中国循证心血管医学杂志, 2017, 9(7): 848-850.
[10] Neumann, F.J., Sousa-Uva, M., Ahlsson, A., et al. (2019) 2018 ESC/EACTS Guidelines on Myocardial Revascularization. European Heart Journal, 40, 87-165. [Google Scholar] [CrossRef] [PubMed]
[11] Tomaniak, M., Masdjedi, K., van Zandvoort, L.J., et al. (2021) Correlation between 3D-QCA Based FFR and Quantitative Lumen Assessment by IVUS for Left Main Coronary Artery Stenoses. Catheterization and Cardiovascular Interventions, 97, E495-E501. [Google Scholar] [CrossRef] [PubMed]
[12] Fujino, Y., Bezerra, H.G., Attizzani, G.F., et al. (2013) Frequency-Domain Optical Coherence Tomography Assessment of Unprotected Left Main Coronary Artery Disease—A Comparison with Intravascular Ultrasound. Catheterization and Cardiovascular Interventions, 82, E173-E183. [Google Scholar] [CrossRef] [PubMed]
[13] Kubo, T., Shinke, T., Okamura, T., et al. (2017) Optical Frequency Domain Imaging vs. Intravascular Ultrasound in Percutaneous Coronary Intervention (Opinion Trial): One-Year Angiographic and Clinical Results. European Heart Journal, 38, 3139-3147. [Google Scholar] [CrossRef] [PubMed]
[14] Shimamura, K., Kubo, T. and Akasaka, T. (2021) Evaluation of Cor-onary Plaques and Atherosclerosis Using Optical Coherence Tomography. Expert Review of Cardiovascular Therapy, 19, 379-386. [Google Scholar] [CrossRef] [PubMed]
[15] 王伟民, 霍勇, 葛均波. 冠状动脉钙化病变诊治中国专家共识(2021版) [J]. 中国介入心脏病学杂志, 2021, 29(5): 251-259.
[16] Onuma, Y., Katagiri, Y., Burzotta, F., et al. (2019) Joint Consensus on the Use of OCT in Coronary Bifurcation Lesions by the European and Japanese Bifurcation Clubs. EuroIntervention, 14, e1568-e1577. [Google Scholar] [CrossRef
[17] de la Torre, H.J., Garcia, C.T., Baz, A.J., et al. (2020) Outcomes of Predefined Optimisation Criteria for Intravascular Ultrasound Guidance of Left Main Stenting. EuroIntervention, 16, 210-217. [Google Scholar] [CrossRef
[18] Ali, Z.A., Maehara, A., Généreux, P., et al. (2016) Optical Coherence Tomography Compared with Intravascular Ultrasound and with Angiography to Guide Coronary Stent Im-plantation (ILUMIEN III: OPTIMIZE PCI): A Randomised Controlled Trial. The Lancet, 388, 2618-2628. [Google Scholar] [CrossRef
[19] Ha, F.J., Giblett, J.P., Nerlekar, N., et al. (2017) Optical Co-herence Tomography Guided Percutaneous Coronary Intervention. Heart, Lung and Circulation, 26, 1267-1276. [Google Scholar] [CrossRef] [PubMed]
[20] Porchetta, N., Russo, D., Benedetto, D., et al. (2021) Plaque Pro-lapse after Stent Implantation in Ectasiant Coronary Artery Atherosclerotic Disease and Large Plaque Burden. Journal of Cardiovascular Echography, 31, 181-183.
[21] Hong, Y.J., Jeong, M.H., Choi, Y.H., et al. (2013) Impact of Tissue Prolapse after Stent Implantation on Short- and Long-Term Clinical Outcomes in Patients with Acute Myocardial Infarc-tion: An Intravascular Ultrasound Analysis. International Journal of Cardiology, 166, 646-651. [Google Scholar] [CrossRef] [PubMed]
[22] Goldstein, J.A. (2015) Stent Edge Dissection: Depth of Injury and Adverse Outcome. Catheterization and Cardiovascular Interventions, 86, 247-248. [Google Scholar] [CrossRef] [PubMed]
[23] Maehara, A., Ben-Yehuda, O., Ali, Z., et al. (2015) Comparison of Stent Expansion Guided by Optical Coherence Tomography versus Intravascular Ultrasound: The ILUMIEN II Study (Obser-vational Study of Optical Coherence Tomography [OCT] in Patients Undergoing Fractional Flow Reserve [FFR] and Percutaneous Coronary Intervention). JACC: Cardiovascular Interventions, 8, 1704-1714. [Google Scholar] [CrossRef] [PubMed]
[24] Prati, F., Romagnoli, E., Burzotta, F., et al. (2015) Clinical Impact of OCT Findings during PCI: The CLI-OPCI II Study. JACC: Cardiovascular Imaging, 8, 1297-1305. [Google Scholar] [CrossRef] [PubMed]
[25] Kobayashi, N., Mintz, G.S., Witzenbichler, B., et al. (2016) Prev-alence, Features, and Prognostic Importance of Edge Dissection after Drug-Eluting Stent Implantation: An ADAPT-DES Intravascular Ultrasound Substudy. Circulation: Cardiovascular Interventions, 9, e3553. [Google Scholar] [CrossRef
[26] Nogic, J., Prosser, H., O’Brien, J., et al. (2020) The Assessment of Intermediate Coronary Lesions Using Intracoronary Imaging. Cardiovascular Diagnosis and Thera-py, 10, 1445-1460. [Google Scholar] [CrossRef] [PubMed]
[27] Shah, R., Morsy, M.S., Weiman, D.S., et al. (2017) Meta-Analysis Comparing Coronary Artery Bypass Grafting to Drug-Eluting Stents and to Medical Therapy Alone for Left Main Coronary Artery Disease. American Journal of Cardiology, 120, 63-68. [Google Scholar] [CrossRef] [PubMed]
[28] Park, S.J., Ahn, J.M., Kang, S.J., et al. (2014) Intravascular Ultrasound-Derived Minimal Lumen Area Criteria for Functionally Significant Left Main Coronary Artery Stenosis. JACC: Cardiovascular Interventions, 7, 868-874. [Google Scholar] [CrossRef] [PubMed]
[29] Thuijs, D., Kappetein, A.P., Serruys, P.W., et al. (2019) Percutane-ous Coronary Intervention versus Coronary Artery Bypass Grafting in Patients with Three-Vessel or Left Main Coronary Artery Disease: 10-Year Follow-Up of the Multicentre Randomised Controlled SYNTAX Trial. The Lancet, 394, 1325-1334. [Google Scholar] [CrossRef
[30] Sabatine, M., Bergmark, B.A., Murphy, S.A., et al. (2021) Percutaneous Coronary Intervention with Drug-Eluting Stents versus Coronary Artery Bypass Grafting in Left Main Coronary Artery Disease: An Individual Patient Data Meta-Analysis. The Lancet, 398, 2247-2257. [Google Scholar] [CrossRef
[31] Thuijs, D., Head, S.J., Stone, G.W., et al. (2019) Outcomes Following Surgical Revascularization with Single versus Bilateral Internal Thoracic Arterial Grafts in Patients with Left Main Coronary Artery Disease Undergoing Coronary Artery Bypass Grafting: Insights from the EXCEL Trial. Europe-an Journal of Cardio-Thoracic Surgery, 55, 501-510. [Google Scholar] [CrossRef] [PubMed]
[32] Holm, N.R., Mäkikallio, T., Lindsay, M.M., et al. (2020) Percutaneous Coronary Angioplasty versus Coronary Artery Bypass Grafting in the Treatment of Unprotected Left Main Stenosis: Updated 5-Year Outcomes from the Randomised, Non-Inferiority NOBLE Trial. The Lancet, 395, 191-199. [Google Scholar] [CrossRef
[33] Giustino, G., Serruys, P.W., Sabik, J.R., et al. (2020) Mor-tality after Repeat Revascularization Following PCI or CABG for Left Main Disease: The EXCEL Trial. JACC: Cardio-vascular Interventions, 13, 375-387. [Google Scholar] [CrossRef] [PubMed]
[34] Suleiman, S., Coughlan, J.J., Touma, G., et al. (2021) Contempo-rary Management of Isolated Ostial Side Branch Disease: An Evidence-Based Approach to Medina 001 Bifurcations. In-terventional Cardiology, 16, e6. [Google Scholar] [CrossRef] [PubMed]
[35] Kan, J., Zhang, J.J., Sheiban, I., et al. (2022) 3-Year Outcomes after 2-Stent with Provisional Stenting for Complex Bifurcation Lesions Defined by Definition Criteria. JACC: Cardiovascu-lar Interventions, 15, 1310-1320. [Google Scholar] [CrossRef] [PubMed]
[36] Takahashi, K., Serruys, P.W., Fuster, V., et al. (2020) Redevelop-ment and Validation of the SYNTAX Score II to Individualise Decision Making between Percutaneous and Surgical Re-vascularisation in Patients with Complex Coronary Artery Disease: Secondary Analysis of the Multicentre Randomised Controlled SYNTAXES Trial with External Cohort Validation. The Lancet, 396, 1399-1412. [Google Scholar] [CrossRef
[37] Chen, S.L., Sheiban, I., Xu, B., et al. (2014) 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). JACC: Cardiovascular Interventions, 7, 1266- 1276.
[38] D’Ascenzo, F., Iannaccone, M., Giordana, F., et al. (2016) Provisional vs. Two-Stent Technique for Unprotected Left Main Coronary Artery Disease after Ten Years Follow Up: A Propensity Matched Analysis. International Journal of Cardiology, 211, 37-42. [Google Scholar] [CrossRef] [PubMed]
[39] Stone, G.W., Sabik, J.F., Serruys, P.W., et al. (2016) Everoli-mus-Eluting Stents or Bypass Surgery for Left Main Coronary Artery Disease. The New England Journal of Medicine, 375, 2223-2235. [Google Scholar] [CrossRef
[40] Hahn, J.Y., Chun, W.J., Kim, J.H., et al. (2013) Predictors and Outcomes of Side Branch Occlusion after Main Vessel Stenting in Coronary Bifurcation Lesions: Results from the COBIS II Registry (Coronary Bifurcation Stenting). JACC: Journal of the American College of Cardiology, 62, 1654-1659. [Google Scholar] [CrossRef] [PubMed]
[41] Finet, G., Derimay, F., Motreff, P., et al. (2015) Com-parative Analysis of Sequential Proximal Optimizing Technique Versus Kissing Balloon Inflation Technique in Provi-sional Bifurcation Stenting: Fractal Coronary Bifurcation Bench Test. JACC: Cardiovascular Interventions, 8, 1308-1317. [Google Scholar] [CrossRef] [PubMed]
[42] Burzotta, F., Džavík, V., Ferenc, M., et al. (2015) Technical As-pects of the T and Small Protrusion (TAP) Technique. EuroIntervention, 11, V91-V95. [Google Scholar] [CrossRef
[43] Chen, S.L., Xu, B., Han, Y.L., et al. (2015) Clinical Outcome after DK Crush versus Culotte Stenting of Distal Left Main Bifurcation Lesions: The 3-Year Follow-Up Results of the DKCRUSH-III Study. JACC: Cardiovascular Interventions, 8, 1335-1342. [Google Scholar] [CrossRef] [PubMed]
[44] Chen, L., Fan, L., Luo, Y., et al. (2016) Ex Vivo Monoring Tech-nique Simplifies Culotte Stenting for Treatment of True Bifurcation Lesions: Insights from Bench Testing and Clinical Application. Cardiology Journal, 23, 673-684. [Google Scholar] [CrossRef