Strupp G, Bonzel T, Schreiner G, Lin Y, Plappert B, Conze M, Volmar J, Zeplin H, Stegmann T
Medizinische Klinik I, Städtisches Klinikum Fulda.
Z Kardiol. 1992 Sep;81(9):500-6.
The value of stenting in emergency situations in interventional angioplasty procedures is widely accepted. Stenting remains controversial as a therapeutic method for use beyond the acute phase, as the results reported in the acute phase are characterized by a wide range. This study reports the implantation results of Palmaz-Schatz stents in 64 cases mostly for failed PTCA. Stents were mounted on Monorail-PVC-balloon catheters. The acute success rate was 96.8%. In two cases with stent misplacement CABG was performed within 48 h. No lethal events occurred in the acute phase. Stent thrombosis has only been seen in four cases (6.5%) so far under subtle monitoring of the anticoagulant regime. Restenosis rate (definition: NHLBI-4) according to serial angiography 6 and 12 weeks after implantation was 4.25% at 6 weeks, with a cumulative rate of 19.4% up to 12 weeks. All recurrences eligible for PTCA have been successfully redilated. A high extracardiac complication rate--predominantly groin hematoma--is the main disadvantage of the procedure. Surgical repair was necessary in 11.4% up to 6 weeks after implantation. Surprisingly high was also the incidence of hematuria, also in 11.4%, in the phase of high anticoagulation. In conclusion, stenting is an effective therapeutic method to avoid emergency CABG and elective CABG in most cases of failed PTCA.
支架置入术在介入血管成形术紧急情况下的价值已被广泛认可。作为急性期后的一种治疗方法,支架置入术仍存在争议,因为急性期报告的结果差异很大。本研究报告了64例主要因PTCA失败而植入Palmaz-Schatz支架的结果。支架安装在单轨PVC球囊导管上。急性成功率为96.8%。在两例支架放置错误的病例中,在48小时内进行了冠状动脉旁路移植术(CABG)。急性期未发生致命事件。在对抗凝方案进行精细监测的情况下,迄今为止仅在4例(6.5%)中观察到支架血栓形成。根据植入后6周和12周的系列血管造影,再狭窄率(定义:NHLBI-4)在6周时为4.25%,至12周时累积率为19.4%。所有适合PTCA的复发均已成功再次扩张。心脏外并发症发生率高——主要是腹股沟血肿——是该手术的主要缺点。植入后6周内,11.4%的患者需要手术修复。令人惊讶的是,在高抗凝阶段,血尿的发生率也很高,同样为11.4%。总之,在大多数PTCA失败的病例中,支架置入术是避免紧急CABG和择期CABG的有效治疗方法。