Antonio Colombo教授：Colombo博士是意大利米兰哥伦布医院心脏导管室主任，兼任San Raffaele医院介入心脏病科主任。目前Colombo博士是哥伦比亚大学医学院的访问教授。
International Circulation: Stent thrombosis is an important risk factor for ischemic events after DES implantation， and this happens more frequently in complex bifurcation lesions. Do you think it is necessary to prolong duration of dual antiplatelet therapy in these types of lesions?
Dr Colombo: I do not believe that we need to prolong the duration of dual antiplatelet therapy in bifurcation lesions provided that we are happy about the optimum result that we have achieved. It is important to note that new generation stents especially those with bioabsorbable polymer， have shown overall a lower rate of thrombosis compared to the first generation stents. We also know that in bifurcations treated with one stent or two stents， provided the operator is confident that the result is optimal， there is really no increase in stent thrombosis even with first generation stents. So I believe if you put these two variables together – optimal result and second generation stents – I do not see any reason to increase the duration of dual antiplatelet therapy.
《国际循环》：支架内血栓形成是DES置入术后发生缺血事件的重要危险因素之一，多发生于复杂的分叉病变。您是否认为对这类病变有必要延长患者的双联抗血小板疗程？
Dr Colombo：我认为对于分叉病变患者不需要延长双联抗血小板治疗的疗程，因为我们已经取得了令人满意的最佳结果。必须指出新一代支架尤其是使用了生物可吸收聚合物的支架，已经显示了比第一代支架更低的血栓形成发生率。此外，对于置入了1枚或2枚支架的分叉病变，在手术者对手术操作取得最佳结果已有足够自信的前提下，即使是使用了第一代支架，支架内血栓形成的发生率也的确没有增加。因此我相信，如果你已将2个因素合二为一——最佳的结果和第二代支架——我实在没有任何理由去延长双联抗血小板治疗的疗程。
International Circulation: Incidence of stent malapposition is relatively higher in PCI in complex bifurcation lesions. Could you talk about your experience in preventing stent malapposition in complex bifurcation lesions?
Dr Colombo: In bifurcation lesions， most of the malapposition is acute malapposition， which means that at the end of the procedure the stent has not been deployed appropriately and this is the one that we can prevent and we should prevent. An acquired malapposition is really an event due to the toxicity of the medication on the polymer which seems to be much lower in the second generation stents. In acute malapposition， I believe the best way to check the result is with IVUS. IVUS will tell us if the stent is well deployed and that there is good contact between the wall and the stent struts and will tell us what to do in order to improve the result.
《国际循环》：在复杂分叉病变的PCI术中，支架贴壁不良的发生率仍然相当高。能否请您谈谈您在复杂分叉病变PCI术中避免支架贴壁不良的经验？
Dr Colombo：在分叉病变PCI术中，大多数贴壁不良是一个急性过程，即在手术即将结束时支架未被恰当地释放，这是我们能够、也是应该避免的。获得性贴壁不良实际上是因聚合物中的药物的毒性所造成的事件，在第二代支架中这种情况已经非常少见。对于急性贴壁不良，我认为最好的办法是使用IVUS检查支架释放后的结果。IVUS将告诉我们支架是否被正确地释放，以及血管壁和支架杆之间是否贴附良好，并告诉我们应如何采取措施以改善结果。
International Circulation: There is still controversy about whether a single-stent approach or a complex 2-stent approach is better in treating bifurcation lesions. What is your opinion on this problem and what changes to the approach in PCI need to be made?
Dr Colombo: I am not so sure that we have such a controversy. I think the controversy is in how frequently we use a 2-stent approach. Some interventionists say we need two stents in 20% of bifurcation cases. Others say we need it in 30-35% of cases. We all agree that not every bifurcation can be treated with one stent and there are some complex bifurcations that need two stents. The only number we are debating here is in how many we really need two stents. Some people are more aggressive and suggest one-third of cases; others suggest one-fifth. I think the major debate however is over.
《国际循环》：对于到底应该采用单支架策略还是复杂的双支架策略治疗分叉病变的争议仍在继续。您对这一问题持何种观点？您认为应作出哪些改变？
Dr Colombo: 我并不认为还存在这种争议。我认为争议在于使用双支架策略的频率。一些介入专家称，在20%的分叉病变患者中需要置入2枚支架；另外一些人则说该比例为30%~35%。我们都同意以下观点，即并非每1例分叉病变都可以通过置入1枚支架来解决，的确有一些复杂分叉病变需要置入2枚支架。我们争论的唯一话题就是，到底有多少分叉病变真正需要置入2枚支架。一些专家更为积极，认为有三分之一的病例；而另外一些专家认为是五分之一。然而，我认为最大的争议已经结束了。
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