冠心病分叉病变新型双支架技术的支架形态学与血流动力学研究

Two-stent technique (TST) is a necessary intervention strategy during coronary bifurcation intervention for high-risk bifurcation lesions. However, currently applied TST methods all have their morphological or structural limitations with respect to metallic neo-carina and hemodynamics status. Struts malapposition and unsatisfactory hemodynamics parameters are potential reasons of in-stent restenosis and in-stent thrombosis. Double Rewire crush stent technique (DR-CRUSH) is a novel TST method which was first used in Fuwai Hospital. DR-CRUSH technique was shown to be feasible with perfect angiographic performance in pilot study. Also, DR-CRUSH technique was found to be associated with smaller metallic neo-carina and higher success rate. These results led us to hypothesize that DR-CRUSH technique may provide more natural stent morphometry and optimal hemodynamics status by decreasing metallic neo-carina formation. To test our hypothesis, at first, we will establish the in-vitro model of DR-CRUSH technique as well as a previous widely used TST method (DK-CRUSH technique). Next, we will compare the stent morphometry and hemodynamics parameters between these two TST methods. We hope to verify the DR-CRUSH technique is an optimal TST method for complex coronary bifurcation lesions, dissect its underlying mechanism, and provide a better choice and prognosis for patients undergoing coronary bifurcation intervention.

双支架技术(TST)是复杂冠脉分叉病变介入治疗的必要选择，但仍无一种TST技术能够尽如人意：既可保证操作成功率，又能在分叉局部建立理想的支架形态及血流动力学状态。不理想的支架形态与血流动力学状态是导致支架内血栓形成和支架内再狭窄的重要因素。DR-CRUSH双支架技术是首先在我院应用的一种TST技术，有优越的影像学表现，在预实验中发现，应用DR-CRUSH技术时，操作简便且成功率高，无明显支架钢丝凸入管腔形成金属界嵴。据此，推测DR-CRUSH技术能通过减少金属界嵴的形成，塑造更加接近自然血管的支架形态，进而形成更加理想的血流动力学状态。在前期研究基础上，本项目拟通过建立DR-CRUSH技术及既往TST技术(DK-CRUSH技术)的体外模型，对比不同TST术中、术后的支架形态及血流动力学状态，从而阐明DR-CRUSH术式的潜在优势及其机制，为冠脉分叉病变介入治疗提供更优的术式选择和临床预后。

双支架技术是复杂冠脉分叉病变介入治疗的必要选择，既往无一种双支架技术能够尽如人意：既可保证操作成功率，又能在分叉局部建立理想的支架形态及血流动力学状态。不理想的支架形态与血流动力学状态是导致支架内血栓形成和支架内再狭窄的重要因素。DR-CRUSH双支架技术是首先在我院应用的一种双支架技术，有优越的影像学表现。本课题选取在临床研究中被广泛关注的DK-CRUSH双支架技术作为对照组，通过体外模拟建立支架模型，并进行Micro CT扫描及血流动力学分析，展示了两种术式的操作难以程度、支架形态及血流动力学状态。发现DR-CRUSH双支架技术有以下优势：①操作中分支支架钢丝不会凸入主支血管，保障了主支管腔的通畅，确保主支支架顺利通过，可提高操作成功率；②全部操作过程仅需1次对吻扩张，操作简单，降低了操作难度，缩短了操作时间；③尽量避免形成金属界嵴，对血流动力学的影响小，使分叉血管最大程度上接近正常血管的自然理想形态。本课题从基础研究的层面证明了DR-CRUSH双支架技术的优势，为其后续临床研究及推广应用提供了理论基础。