Nikolsky Evgenia, Gruberg Luis, Pechersky Sirush, Kapeliovich Michael, Grenadier Ehud, Amikam Shlomo, Boulos Monther, Suleiman Mahmoud, Markiewicz Walter, Beyar Rafael
Division of Invasive Cardiology, Rambam Medical Center and Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
Catheter Cardiovasc Interv. 2003 Jul;59(3):324-8. doi: 10.1002/ccd.10543.
Stents have revolutionized percutaneous coronary interventions (PCI), impacting on both acute and long-term results. However, despite improvements in stent design, stent deployment failure is not an unusual event. The aim of the present study was to assess the frequency and causes of stent deployment failure, as well as the outcome of these patients. Between 1997 and 2001, a total of 3,537 patients underwent stent-assisted PCI and delivery of 5,275 stents was attempted. In the majority of patients (118; 78.1%), stenting was performed as provisional; in the remaining 33 (21.8%) as a bailout procedure. A total of 175 (3.3%) stents in 151 (4.3%) patients failed. Failure to deliver the stent to the lesion site was the main cause in 139 patients (92%) and failure either to expand adequately the stent or premature disengagement of the stent from the balloon in only 12 patients (8%). Peripheral stent embolization occurred in 10 (0.3%) patients. Deployment of a different stent in place of the failed one was attempted in 122 patients and was successful in the majority (108; 88.5%). In-hospital major adverse cardiac events were observed in six patients (4%): three patients required emergency coronary artery bypass surgery, two had a myocardial infarction (MI), and one patient underwent urgent repeat coronary intervention. At a mean follow-up of 32.2 +/- 17.7 months, 22 major adverse cardiac event occurred in 17 patients (11.2%): 1 cardiac death, 3 patients had an MI, and 18 patients required target vessel revascularization. One-year event-free survival for the whole group was 91.2%. Patients with stent embolization did not have any major adverse cardiac or vascular events. Thus, the rate of stent deployment failure in our series was 3.3%, mainly due to failure to deliver the stent to the site. Another stent was successfully deployed in the majority of cases and these patients had favorable short- and long-term outcomes.
支架彻底改变了经皮冠状动脉介入治疗（PCI），对急性和长期治疗结果均产生了影响。然而，尽管支架设计有所改进，但支架植入失败并非罕见事件。本研究的目的是评估支架植入失败的频率和原因，以及这些患者的治疗结果。1997年至2001年间，共有3537例患者接受了支架辅助PCI治疗，并尝试植入5275枚支架。大多数患者（118例；78.1%）的支架植入为临时植入；其余33例（21.8%）为补救措施。151例（4.3%）患者中的175枚支架（3.3%）植入失败。139例患者（92%）的主要原因是未能将支架输送至病变部位，仅12例患者（8%）的原因是支架未能充分扩张或支架与球囊过早脱离。10例（0.3%）患者发生外周支架栓塞。122例患者尝试用不同的支架替代失败的支架，大多数患者（108例；88.5%）获得成功。6例患者（4%）发生院内主要不良心脏事件：3例患者需要紧急冠状动脉搭桥手术，2例发生心肌梗死（MI），1例患者接受了紧急重复冠状动脉介入治疗。平均随访32.2±17.7个月时，17例患者（11.2%）发生22例主要不良心脏事件：1例心源性死亡，3例患者发生MI，18例患者需要进行靶血管血运重建。全组1年无事件生存率为91.2%。发生支架栓塞的患者未发生任何主要不良心脏或血管事件。因此，我们系列研究中的支架植入失败率为3.3%，主要原因是未能将支架输送至病变部位。在大多数情况下，成功植入了另一枚支架，这些患者的短期和长期治疗结果良好。
