Stefanadis C, Toutouzas K, Tsiamis E, Vlachopoulos C, Kallikazaros I, Stratos C, Vavuranakis M, Toutouzas P
Department of Cardiology, Hippokration Hospital, University of Athens, Greece.
Am Heart J. 2000 Mar;139(3):437-45. doi: 10.1016/s0002-8703(00)90087-5.
Previous experimental studies with a new covered stent, the autologous venous graft-covered stent (AVGCS), have shown favorable results. The aim of this study was to evaluate the feasibility and safety of this new technique in human coronary arteries and to compare the long-term outcome with uncovered stents.
A venous graft was removed from an upper limb. A conventional stent then was covered by the venous graft. Fifty-eight AVGCS were implanted in 56 patients, including 16 patients with acute coronary syndromes (ACS). Additionally, in 114 patients, 138 uncovered stents were implanted, serving as a control group, including 38 patients with ACS. The procedure was successful in all patients. Stent thrombosis was observed in 3 patients in the control group and in 1 patient with an AVGCS. There was a trend for the minimal luminal diameter to be greater in the AVGCS group at follow-up (P =.07), and statistical significance was observed in patients with ACS (P <.01). The target vessel revascularization and the restenosis rates were similar between the 2 groups. In patients with ACS, the restenosis rate was less (P <.04) and there was a trend for target vessel revascularization to be less in covered stents (P =.09). The event-free survival rate at 4 years was 85% in the AVGCS group versus 81% in the control group (P = not significant); in ACS it was 94% versus 78%, respectively (P = not significant). Stents covered by thicker venous grafts were associated with improved clinical outcome.
Stents covered by autologous venous grafts may be safely prepared without complications. This technique may prove to be a useful means, especially in patients with ACS.
先前对一种新型带膜支架——自体静脉移植物带膜支架（AVGCS）进行的实验研究已显示出良好的效果。本研究的目的是评估这项新技术在人体冠状动脉中的可行性和安全性，并将其长期结果与裸支架进行比较。
从上肢取下一段静脉移植物。然后用该静脉移植物覆盖一个传统支架。58个AVGCS被植入56例患者体内，其中包括16例急性冠状动脉综合征（ACS）患者。此外，114例患者植入了138个裸支架作为对照组，其中包括38例ACS患者。所有患者的手术均成功。对照组有3例患者发生支架血栓形成，AVGCS组有1例患者发生支架血栓形成。随访时AVGCS组的最小管腔直径有增大趋势（P = 0.07），在ACS患者中观察到统计学意义（P < 0.01）。两组的靶血管血运重建率和再狭窄率相似。在ACS患者中，再狭窄率较低（P < 0.04），带膜支架的靶血管血运重建有减少趋势（P = 0.09）。AVGCS组4年无事件生存率为85%，对照组为81%（P无统计学意义）；在ACS患者中分别为94%和78%（P无统计学意义）。用较厚静脉移植物覆盖的支架与改善的临床结果相关。
自体静脉移植物覆盖的支架可以安全制备且无并发症。这项技术可能被证明是一种有用的方法，尤其是在ACS患者中。
