Seabra-Gomes R, Almeida M, Cavaco D, Bettencourt V, Baptista J, Marques A L, Pereira H, Farto e Abreu P, dos Santos L P
Instituto do Coração Av. Prof. Reynaldo dos Santos, 27 Carnaxide-2795-523 Linda-a-Velha Portugal.
Rev Port Cardiol. 2001 Sep;20(9):841-55.
The restenosis rate of stents implanted into small coronary arteries is considered higher than that of stents in arteries > or = 3 mm, but could be influenced by clinical parameters and by the type and length of the stents.
To assess the incidence of angiographic restenosis at 6 months after implantation of 2.5 mm ACS RX Multi-Link (ML) stents, 15 and 25 mm length, in de novo coronary stenosis.
Angiographic substudy of the Portuguese Multi-Link 2.5 Registry, which included Interventional Cardiology centers with facilities for coronary angiographic recordings allowing quantitative analysis.
Between April 7 and November 20 1998 and in the 5 hospitals that agreed to participate, 61 patients were enrolled and 40 selected as having procedural and 6-month angiographies of sufficient quality for quantitative analysis. The only significant differences in the demographic, clinical and angiographic characteristics of the patients relative to those of the Registry were the lower prevalence of unstable angina and smoking in the angiographic substudy. There were 43 lesions and 46 ML stents were implanted. In 37% the lesions were located in the LAD, in 37% in the LCx and 26% in the RCA. 29 stents of 15 mm length and 17 stents of 25 mm were used.
The morphologic characteristics of the lesions were analyzed subjectively using the AHA/ACC classification. Quantitative coronary analysis (QCA) was performed, in an independent laboratory using the CAAS 2 system, for reference vessel diameter, lesion length, percentage of stenosis, minimum lumen diameter (MLD) and related parameters. Restenosis was defined as > or = 50% lumen obstruction at 6-month angiography.
In the subjective analysis, 2 lesions were type B1, 27 type B2 and 14 type C. The overall restenosis rate was 32.6%. Restenosis was 27.7% for 15 mm stents and 36% for 25 mm stents (p = 0.4). For the QCA parameters analyzed, only MLD at the end of stent implantation was a predictor of 6-month restenosis (2.19 +/- 0.30 without vs. 2.03 +/- 0.18 with restenosis, p = 0.048).
The restenosis rate of the Multi-Link 2.5 mm stents, of 15 and 25 mm length, was similar to that described with other types of stents in small coronary arteries. Minimum lumen diameter after stenting was found to be the best predictor of 6-month restenosis.
植入小冠状动脉的支架再狭窄率被认为高于植入直径≥3mm动脉的支架，但可能受临床参数以及支架类型和长度的影响。
评估在初发冠状动脉狭窄中植入长度为15和25mm的2.5mm ACS RX多链接（ML）支架6个月后血管造影再狭窄的发生率。
葡萄牙多链接2.5注册研究的血管造影子研究，该研究包括具备冠状动脉血管造影记录设施并允许进行定量分析的介入心脏病学中心。
在1998年4月7日至11月20日期间，在5家同意参与的医院中，61例患者入组，40例患者被选为具备质量足以进行定量分析的手术和6个月血管造影检查。与注册研究中的患者相比，入选患者在人口统计学、临床和血管造影特征方面唯一显著的差异是不稳定型心绞痛和吸烟的患病率在血管造影子研究中较低。共43处病变，植入了46枚ML支架。37%的病变位于左前降支（LAD），37%位于左旋支（LCx），26%位于右冠状动脉（RCA）。使用了29枚15mm长的支架和17枚25mm长的支架。
使用美国心脏协会/美国心脏病学会（AHA/ACC）分类主观分析病变的形态学特征。在一个独立实验室使用CAAS 2系统进行冠状动脉定量分析（QCA），以测量参考血管直径、病变长度、狭窄百分比、最小管腔直径（MLD）及相关参数。再狭窄定义为6个月血管造影时管腔阻塞≥50%。
主观分析中，2处病变为B1型，27处为B2型，14处为C型。总体再狭窄率为32.6%。15mm支架的再狭窄率为27.7%，25mm支架为36%（p = 0.4）。对于所分析的QCA参数，仅支架植入结束时的MLD是6个月再狭窄的预测指标（无再狭窄者为2.19±0.30，有再狭窄者为2.03±0.18，p = 0.048）。
长度为15和25mm的多链接2.5mm支架的再狭窄率与小冠状动脉中其他类型支架的再狭窄率相似。支架置入后的最小管腔直径是6个月再狭窄的最佳预测指标。
