Mauri Laura, O'Malley A James, Popma Jeffrey J, Moses Jeffrey W, Leon Martin B, Holmes David R, Teirstein Paul S, Cutlip Donald E, Donahoe Dennis, Kuntz Richard E
Brigham and Women's Hospital, Boston, Massachusetts 02115, USA.
Am J Cardiol. 2005 May 15;95(10):1140-5. doi: 10.1016/j.amjcard.2005.01.039.
Selection of coronary stent length varies from covering only the zone of maximum obstruction to stenting from normal- to normal-appearing vessels. With bare metal stenting, for any given lesion there is a high restenotic risk associated with longer stent length. With drug-eluting stents, the relation between stent length and restenosis has not been evaluated. In the angiographic follow-up cohort of the SIRIUS trial that compared the sirolimus-eluting Bx Velocity stent with the standard Bx Velocity stent (n = 699), we constructed a multiple regression model to predict 8-month percent diameter stenosis using the main effects of lesion length and excess stent length beyond the lesion length and adjusting for known predictors of restenosis. Stent length exceeded lesion length in 94% of lesions overall. Mean difference in length was 8.3 +/- 8.3 mm (mean lesion length 14.6 +/- 5.9 mm, mean stent length 22.9 +/- 9.6 mm). Stented lesion length and excess stent length were associated with absolute increases in percent diameter stenosis per 10 mm of 9.1% (p <0.0001) and 3.6% (p = 0.053) in the bare metal arm and 3.5% (p = 0.047) and 2.1% (p = 0.040) in the sirolimus-eluting stent arm. Although the effects of lesion length and excess stent length on restenosis were markedly decreased with sirolimus-eluting stents (vs bare metal stents), a small restenotic penalty is still paid for excessive stent length. Longer stent-to-lesion length strategies should be used only when a shorter stent is likely to result in incomplete lesion coverage and edge dissection, a strong determinant of stent thrombosis.
冠状动脉支架长度的选择范围很广，从仅覆盖最大狭窄区域到从外观正常的血管至正常血管进行支架置入。对于裸金属支架，对于任何给定病变，较长的支架长度都与较高的再狭窄风险相关。对于药物洗脱支架，支架长度与再狭窄之间的关系尚未得到评估。在比较西罗莫司洗脱Bx Velocity支架与标准Bx Velocity支架（n = 699）的SIRIUS试验的血管造影随访队列中，我们构建了一个多元回归模型，使用病变长度和超出病变长度的额外支架长度的主要效应，并对已知的再狭窄预测因素进行调整，来预测8个月时的直径狭窄百分比。总体而言，94%的病变中支架长度超过了病变长度。长度的平均差异为8.3±8.3毫米（平均病变长度14.6±5.9毫米，平均支架长度22.9±9.6毫米）。在裸金属支架组中，每10毫米的支架病变长度和额外支架长度与直径狭窄百分比的绝对增加分别相关9.1%（p <0.0001）和3.6%（p = 0.053），在西罗莫司洗脱支架组中分别为3.5%（p = 0.047）和2.1%（p = 0.040）。尽管与裸金属支架相比，西罗莫司洗脱支架显著降低了病变长度和额外支架长度对再狭窄的影响，但过长的支架长度仍会带来较小的再狭窄代价。只有当较短的支架可能导致病变覆盖不完全和边缘夹层（支架血栓形成的一个重要决定因素）时，才应采用较长的支架与病变长度策略。
