Manolis A S
Cardiology Section, Patras University, Rio, Greece.
Clin Cardiol. 2001 Feb;24(2):119-26. doi: 10.1002/clc.4960240205.
Over the last 4 years, several newer generation stents have become available, promising to change the scenery of coronary angioplasty (PTCA) with its attendant restenosis rate.
The aim of this study was to review prospectively the results of a single operator adopting a uniform approach with approximately 0.5 mm stent oversizing and high-pressure (> or = 12-16 bar) deployment and compare them with conventional PTCA in a series of 244 consecutive patients.
The study included 203 men and 41 women, aged 59 +/- 11 years, who presented with stable angina and/or positive exercise testing (n = 75), unstable angina (n = 161), or acute myocardial infarction (n = 8). Dilated vessels included the left anterior descending artery (n = 139), the right coronary artery (n = 86), the left circumflex artery (n = 47), the ramus branch (n = 4), or venous grafts (n = 2). Stents were implanted for dissection, suboptimal PTCA result, and electively. Two groups were compared: 83 patients who underwent balloon PTCA alone and 161 patients who also received stent(s).
The two groups had similar demographics, age (58 +/- 10 vs. 59 +/- 11 years), initial vessel stenosis (92 +/- 7 vs. 93 +/- 6%), and left ventricular ejection fraction (51 +/- 9 vs. 51 +/- 8%). Procedural success was also similar (97.6 vs. 99.4%), but as expected the residual stenosis was much lower in the stent group (< or = 0 vs. 17%). The following stents were employed: J & J (n = 1), NIR (n = 117), ACS (n = 59), AVE (n = 9), Inflow GoldFlex (n = 9), Crossflex (n = 5), Wictor (n = 1), Jostent (n = 16), R stent (n = 9), Seaquence (n = 2) and Wallstent (n = 1). Single stents were used in 118 patients, two stents in 31 patients, three in 6 patients, and four in 6 patients. There was one in-hospital death at 3 days unrelated to the procedure. There were no events of subacute stent thrombosis; all patients in the stent group received combined therapy with aspirin and ticlopidine, the latter for 1 month. During 18 +/- 14 months, the clinical restenosis rate was significantly lower in the stent group (6.9%) than in the PTCA group (28.4%) (p = 0.001).
In a series of 244 consecutive patients, newer generation stents and a consistent approach of stent oversizing and high-pressure stent deployment by a single operator resulted in high procedural success (99%), lack of stent thrombosis (0%), and a very low clinical restenosis rate (7%).
在过去4年里，几种新一代支架已面市，有望改变冠状动脉血管成形术（PTCA）及其随之而来的再狭窄率的局面。
本研究的目的是前瞻性地回顾一位单一操作者采用统一方法（支架尺寸过大约0.5毫米并进行高压（≥12 - 16巴）植入）的结果，并将其与244例连续患者的传统PTCA结果进行比较。
该研究纳入了203名男性和41名女性，年龄为59±11岁，表现为稳定型心绞痛和/或运动试验阳性（n = 75）、不稳定型心绞痛（n = 161）或急性心肌梗死（n = 8）。扩张的血管包括左前降支（n = 139）、右冠状动脉（n = 86）、左旋支（n = 47）、分支（n = 4）或静脉桥血管（n = 2）。植入支架用于治疗夹层、PTCA效果欠佳以及选择性情况。比较了两组：83例仅接受球囊PTCA的患者和161例也接受了支架植入的患者。
两组在人口统计学特征、年龄（58±10岁对59±11岁）、初始血管狭窄程度（92±7%对93±6%）和左心室射血分数（51±9%对51±8%）方面相似。手术成功率也相似（97.6%对99.4%），但正如预期的那样，支架组的残余狭窄程度低得多（≤0%对17%）。使用了以下支架：强生（n = 1）、NIR（n = 117）、ACS（n = 59）、AVE（n = 9）、流入型GoldFlex（n = 9）、Crossflex（n = 5）、Wictor（n = 1）、Jostent（n = 16）、R支架（n = 9）、Seaquence（n = 2）和Wallstent（n = 1）。118例患者使用单个支架，31例患者使用两个支架，6例患者使用三个支架，6例患者使用四个支架。有1例3天内的院内死亡与手术无关。没有亚急性支架血栓形成事件；支架组所有患者均接受阿司匹林和噻氯匹定联合治疗，后者使用1个月。在18±14个月期间，支架组的临床再狭窄率（6.9%）显著低于PTCA组（28.4%）（p = 0.001）。
在244例连续患者中，新一代支架以及单一操作者采用的一致的支架尺寸过大和高压支架植入方法导致了高手术成功率（99%）、无支架血栓形成（0%）以及非常低的临床再狭窄率（7%）。
