Wong P H, Wong C M, Ko P T, Lo A Y, Cheng C H, Chen W W, Chow J S
Cardiac Catheterisation Laboratory, Hong Kong Adventist Hospital.
J Invasive Cardiol. 1993 Sep;5(7):267-76.
Between January 1991 and December 1992, 136 Palmaz-Schatz coronary stents were implanted in 113 native coronary arteries in 106 patients. Forty-seven patients presented with stable angina, 50 with unstable angina, 7 with congestive cardiac failure and unstable angina and 2 were asymptomatic. Stenting was carried out in 15 patients for restenosis after coronary angioplasty (PTCA), 32 for significant dissection during PTCA (with 19 acute and 13 threatened closure), 10 for suboptimal PTCA results and 56 for de novo lesions, 52 (92.9%) of which were either ACC/AHA type B or C. Successful delivery was achieved in 97.2% (103/106) of patients or 97.3% (110/113) of vessels. Percent diameter stenosis was reduced from 78 +/- 13% to 4 +/- 11%. There were two subacute stent thromboses (1.9%), resulting in Q-Wave myocardial infarction. Three deaths (2.9%) occurred, all from the group with congestive cardiac failure and unstable angina. Major bleeding/vascular complications occurred in 4 patients (3.9%). All patients were followed up for a mean of 18 months (6 months to 30 months). Eighty-five patients were asymptomatic. Three patients were angina-free but continued to have, albeit improved, congestive cardiac failure. Ten patients had recurrence of angina, all within 6 months of the stenting procedure. Four were treated medically and 4 had PTCA of whom one eventually had coronary bypass surgery. Two patients had new lesions, successfully treated by PTCA or stenting. In conclusion, a high rate of successful delivery of the Palmaz-Schatz coronary stent can be achieved in a wide spectrum of patients with few complications which are mostly related to anticoagulation. It offers very effective bailout for acute closure during PTCA. Despite the presence of unfavorable pre-procedure patient and lesion characteristics, the acute and long term clinical results are encouraging.
1991年1月至1992年12月期间，106例患者的113条冠状动脉植入了136枚帕尔马兹-沙茨冠状动脉支架。47例患者表现为稳定型心绞痛，50例为不稳定型心绞痛，7例为充血性心力衰竭合并不稳定型心绞痛，2例无症状。15例患者因冠状动脉血管成形术（PTCA）后再狭窄接受支架植入，32例因PTCA期间严重夹层（19例急性夹层和13例濒临闭塞），10例因PTCA效果欠佳，56例因新发病变，其中52例（92.9%）为ACC/AHA B型或C型。97.2%（103/106）的患者或97.3%（110/113）的血管成功植入支架。直径狭窄百分比从78±13%降至4±11%。发生两例亚急性支架血栓形成（1.9%），导致Q波心肌梗死。3例患者死亡（2.9%），均来自充血性心力衰竭合并不稳定型心绞痛组。4例患者（3.9%）发生严重出血/血管并发症。所有患者平均随访18个月（6个月至30个月）。85例患者无症状。3例患者无心绞痛，但充血性心力衰竭虽有改善仍持续存在。10例患者心绞痛复发，均在支架植入术后6个月内。4例接受药物治疗，4例接受PTCA，其中1例最终接受冠状动脉搭桥手术。2例患者出现新病变，通过PTCA或支架植入成功治疗。总之，帕尔马兹-沙茨冠状动脉支架在广泛的患者中可实现高成功率的植入，并发症较少，且大多与抗凝有关。它为PTCA期间的急性闭塞提供了非常有效的补救措施。尽管术前患者和病变特征不佳，但急性和长期临床结果令人鼓舞。
