Goodhart D M, Galbraith D, Anderson T J, Traboulsi M, Knudtson M L
McMaster Clinics - Hamilton General Hospital, Hamilton, Canada.
Can J Cardiol. 1999 Aug;15(8):873-8.
To examine the outcome of intracoronary stent placement by 'primary intention', guided by angiography alone, and without the use of postprocedural anticoagulation.
Prospective, observational study.
Canadian university teaching hospital.
Patients (n=559) undergoing urgent or elective percutaneous revascularization procedures (n=616) in whom a preprocedural decision to employ coronary stent placement was made. Emergency and bailout stent procedures were excluded.
Stents were delivered at high pressure (1616 to 1818 kPa) on balloons matched to the proximal reference segment diameter. Adequacy of stent deployment was judged by angiographic criteria alone. Postprocedural medication included acetylsalicylic acid and ticlopidine. Quantitative coronary angiographic analysis was independently performed. Acute procedural outcomes were prospectively collected. Patients were followed for one year.
All but one patient had a successful angiographic result. Periprocedural death (0.3%), Q wave myocardial infarction (MI) (0%), non-Q MI (1.6%) and stent thrombosis (0.6%) were uncommon events. At one year, 96% of patients were alive and free of MI, while 12% of patients required repeat target lesion revascularization.
A primary intention strategy of intracoronary stenting, guided by angiography alone, is a safe and effective approach to percutaneous coronary revascularization.
探讨仅在血管造影引导下“一期”进行冠状动脉内支架置入且术后不使用抗凝治疗的效果。
前瞻性观察性研究。
加拿大大学教学医院。
559例患者（共进行616例经皮血管重建术），这些患者术前已决定采用冠状动脉支架置入术。排除急诊和补救性支架手术。
在与近端参考节段直径匹配的球囊上以高压（1616至1818千帕）输送支架。仅根据血管造影标准判断支架置入是否充分。术后用药包括阿司匹林和噻氯匹定。独立进行定量冠状动脉造影分析。前瞻性收集急性手术结果。对患者进行一年随访。
除1例患者外，所有患者血管造影结果均成功。围手术期死亡（0.3%）、Q波心肌梗死（0%）、非Q波心肌梗死（1.6%）和支架血栓形成（0.6%）均为罕见事件。一年时，96%的患者存活且无心肌梗死，而12%的患者需要再次对靶病变进行血管重建。
仅在血管造影引导下进行冠状动脉内支架置入的一期策略是经皮冠状动脉血管重建的一种安全有效的方法。
