冠状动脉分叉血管双支架术形态学与流体力学的体外模拟与优化研究

Percutaneous coronary intervention (PCI) on coronary bifurcation lesions (CBL) reamins challengeable for interventionists.The dual- stenting strategy has been a necessary option for treating true CBL or CBL with dominant vessel disease.None of the current dual-stenting techniques can effectively recovered the local morphology and/or hemodynamics in the bifurcation area，thereby failling to reduce the rates of instent restenosis(ISR) and instent thrombosis(IST). Our initial data showed that DK-mini-culotte firstly developed by us for treatment of complex CBL did have advantages over the other dual-stenting techniques in terms of techinical feasibility and mid-term clinical outcomes. Accordingly, this project was to created bench dual-stenting model, to heah-to-head compare the difference of the local morphology and hemodynamics in the bifurcation area via simulating the current dominant dual-stenting techniques by bench testing, to identify the ideal dual-stenting techniques, to explore the potential benefits and associated factors of DK-mini-culotte.This study will provide the strategy for reducing ISR and IST as well as the foundmental data for optimizing the dual-stenting techniques and for designing the new generation of stents customized for CBL.

冠状动脉分叉病变（CBL）是经皮冠脉介入治疗（PCI）最具挑战性的病变之一，双支架PCI术是治疗严重真性CBL、主要血管CBL的必要选择。现行的双支架PCI术中尚缺乏一种可充分恢复血管分叉部形态学及流体力学（局部流场）或使之接近正常的理想术式，从而有效地降低支架内再狭窄（ISR）和支架内血栓形成（IST）的风险。我们研发的DK-mini-culotte双支架术式在临床应用中已初步显示其可行性及安全性，且远期ISR和IST的发生率低。在前期研究基础上，本项目拟通过建立现有主流双支架术式及 DK-mini-culotte体外仿真模型，对比各双支架术式的血管/支架形态学和局部流体力学特征，寻找最佳CBL双支架术式，探索DK-mini-culotte术是否有潜在优势及影响因素。研究将为防治ISR和IST提供理论依据和对策，也为CBL支架术式的优化及新支架的设计提供形态学及流体力学的基础性关键数据。

冠状动脉分叉病变（CBL）是经皮冠脉介入治疗（PCI）最具挑战性的病变之一，双支架PCI术是治疗严重真性CBL、主要血管CBL的必要选择。现行的双支架PCI术中尚缺乏一种可充分恢复血管分叉部形态学及流体力学（局部流场）的理想术式，从而有效地降低支架内再狭窄（ISR）和支架内血栓形成（IST）的风险。本课题中通过体外模拟研究较好地展示现有的各种主流双支架术式（包括Classic crush术式、DK-crush术式、Classic culotte术式）以及我们新研发的双对吻微裤裙支架术(double-kissing-mini-culotte, DK-mini- culotte）的血管/支架形态学和局部流体力学特征。DK-mini-culotte术式POC部无环状限制性支架扩张不良、重叠支架少、支架嵴贴壁较好，SB开口面积较大及形状接近正常，分叉局部流场稳定。DK-mini-culotte术式体外模拟的技术特征可能转化为抑制ISR和IST的临床优势，有望成为CBL的优选双支架技术。