Lee Sang Hak, Jang Yangsoo, Oh Sung Jin, Park Kyeong Jin, Moon Yong Sun, Min Ja Won, Yang Joo Young, Jang Gil Jin
Cardiology Division, Yonsei Cardiovascular Center, Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, South Korea.
Catheter Cardiovasc Interv. 2004 Jul;62(3):298-302. doi: 10.1002/ccd.20091.
Intervention of long coronary lesions remains problematic, and optimal treatment strategy is yet to be determined. Despite advancement of stent technology, data are few regarding the efficacy of overlapping stents vs. a single long stent in long coronary lesions. This study was performed to evaluate the results of those strategies for long coronary lesions and to determine the predictors of in-stent restenosis (ISR). Sixty-four lesions (> 20 mm) in 64 patients were treated with either one long stent (group 1, n = 32) or two overlapping stents (group 2, n = 32). Overlapping stents were used at tortuous or calcified lesions and at lesions with diameter discrepancy or significant dissection. Immediate results, follow-up clinical and angiographic outcomes, and predictors of ISR were evaluated. Procedures were successful in all patients in both groups. Clinical and angiographic follow-ups were performed in 54 (84%) cases and 50 (78%) cases, respectively. During the follow-up, major adverse cardiac event occurred in 36% of group 1 and 29% of group 2 (P = 0.56). Six-month ISR rates were 39% in group 1 and 41% in group 2 (P = 0.91). Age (>/= 65 years old) was an independent risk factor of ISR (54% vs. 23%; OR = 4.4; P = 0.04), and distal reference diameter (RD) of less than 2.5 mm tended to predict ISR in multivariate analysis (60% vs. 25%; OR = 3.5; P = 0.06). In conclusion, stent overlapping can be used with outcome similar to that of one long stent in long coronary lesions. The optimal result may be obtained by considering the patient's age and the distal vessel diameter of the lesion.
长冠状动脉病变的介入治疗仍然存在问题，最佳治疗策略尚未确定。尽管支架技术有所进步，但关于长冠状动脉病变中重叠支架与单个长支架疗效的数据很少。本研究旨在评估这些长冠状动脉病变治疗策略的结果，并确定支架内再狭窄（ISR）的预测因素。64例患者的64处病变（>20mm），分别采用单个长支架治疗（第1组，n=32）或两个重叠支架治疗（第2组，n=32）。在迂曲或钙化病变以及存在直径差异或明显夹层的病变处使用重叠支架。评估即刻结果、随访临床和血管造影结果以及ISR的预测因素。两组所有患者的手术均成功。分别对54例（84%）和50例（78%）患者进行了临床和血管造影随访。随访期间，第1组36%的患者和第2组29%的患者发生了主要不良心脏事件（P=0.56）。第1组和第2组的6个月ISR率分别为39%和41%（P=0.91）。年龄（≥65岁）是ISR的独立危险因素（54%对23%；OR=4.4；P=0.04），在多变量分析中，远端参考直径（RD）小于2.5mm倾向于预测ISR（60%对25%；OR=3.5；P=0.06）。总之，在长冠状动脉病变中，重叠支架的使用效果与单个长支架相似。考虑患者年龄和病变远端血管直径可能会获得最佳结果。
