Choi Si-Wan, Lee Cheol Whan, Hong Myeong-Ki, Lee Jae-Hwan, Kim Jae-Joong, Park Seong-Wook, Park Seung-Jung
Department of Medicine, Asan Medical Center, University of Ulsan, Seoul, Korea.
Clin Cardiol. 2003 Jun;26(6):265-8. doi: 10.1002/clc.4950260605.
Few data are available on the efficacy of long stenting for lesions in unselected chronic total occlusion (CTO).
The study was undertaken to evaluate the angiographic restenosis and long-term clinical outcomes after long stent implantation in patients with CTO.
Our retrospective analysis includes a consecutive series of stent implantation in 220 patients with CTO. We compared angiographic restenosis, target lesion revascularization, and long-term clinical outcomes of short stenting (< 20 mm, Group 1, n = 113) with a concurrent series of long stenting (> or = 20 mm, Group 2, n = 107).
Angiographic follow-up was obtained in 174 patients (79.5% of those eligible), and the rates of angiographic restenosis were 19.3% in Group 1 and 33.7% in Group 2 (p < 0.05). In multivariate analysis, the postinterventional minimal lumen diameter was the only independent predictor of restenosis (odds ratio = 0.20, 95% confidence interval 0.08-0.49, p < 0.01). The angiographic restenosis rate was significantly lower in Group 1 than in Group 2 in patients with final minimal lumen diameter < 3.0 mm (28.9 vs. 55.9%, respectively, p < 0.05). However, the angiographic restenosis rate was not significantly different between the two groups in patients with final minimal lumen diameter > or = 3 mm (12.0 vs. 19.2%, respectively, p = NS). During the follow-up (29.1 +/- 10.8 months), there was no difference between the two groups in death, nonfatal myocardial infarction, and target lesion revascularization.
The use of long (> or = 20 mm) versus short (< 20 mm) stents in patients with CTO is associated with a higher angiographic restenosis rate, but there is an equivalent risk of restenosis in selected patients with relatively large-sized vessels.
关于在未经选择的慢性完全闭塞（CTO）病变中进行长支架置入术的疗效，现有数据较少。
本研究旨在评估CTO患者长支架植入术后的血管造影再狭窄情况和长期临床结局。
我们的回顾性分析纳入了连续220例接受CTO支架植入术的患者。我们比较了短支架置入术（<20mm，第1组，n = 113）与同期长支架置入术（≥20mm，第2组，n = 107）的血管造影再狭窄、靶病变血运重建情况以及长期临床结局。
174例患者（占符合条件患者的79.5%）获得了血管造影随访，第1组血管造影再狭窄率为19.3%，第2组为33.7%（p<0.05）。多因素分析显示，介入术后最小管腔直径是再狭窄的唯一独立预测因素（比值比 = 0.20，95%置信区间0.08 - 0.49，p<0.01）。在最终最小管腔直径<3.0mm的患者中，第1组的血管造影再狭窄率显著低于第2组（分别为28.9%和55.9%，p<0.05）。然而，在最终最小管腔直径≥3mm的患者中，两组的血管造影再狭窄率无显著差异（分别为12.0%和19.2%，p = 无显著性差异）。在随访期间（29.1±10.8个月），两组在死亡、非致命性心肌梗死和靶病变血运重建方面无差异。
CTO患者使用长（≥20mm）支架与短（<20mm）支架相比，血管造影再狭窄率更高，但在血管相对较大的特定患者中，再狭窄风险相当。
