Brilakis Emmanouil S, Best Patricia J M, Elesber Ahmad A, Barsness Gregory W, Lennon Ryan J, Holmes David R, Rihal Charanjit S, Garratt Kirk N
Division of Cardiovascular Diseases, University of Texas Southwestern Medical Center, Dallas, Texas 75216, USA.
Catheter Cardiovasc Interv. 2005 Nov;66(3):333-40. doi: 10.1002/ccd.20449.
Our goal was to examine the incidence and consequences of stent loss during percutaneous coronary intervention (PCI) and the retrieval techniques used. We retrospectively reviewed 11,773 consecutive PCI cases involving stents performed at our institution between January 1994 and March 2004 to identify cases of stent loss. Stent loss occurred in 38 of 11,773 PCI procedures involving stents (0.32%; 95% CI = 0.23-0.44%). Mean age of the patients was 67 +/- 11 years and 82% were men. Stent loss occurred more frequently in lesions with calcification and/or significant proximal angulation. In three patients, the stent was crushed and covered with another stent without attempting retrieval. Stent retrieval was attempted in 35 of 38 cases and was successful in 30 (86%). The following retrieval methods were used (more than one method was used in some cases): advancing a balloon through the stent, inflating the balloon, and withdrawing the stent (45%); twirling two wires around the stent (5%); loop snare (26%); biliary forceps (12%); Cook retained fragment retriever (10%); and basket retrieval device (2%). Patients in whom stent loss occurred had a higher incidence of bleeding requiring transfusion (24% vs. 7%; P < 0.001) and more often required emergency coronary artery bypass surgery (5% vs. 0.4%; P < 0.001). No patients in whom the stent was crushed or deployed in the coronary artery had any major cardiac complication. Stent loss during PCI occurs infrequently. Lost stents can be successfully retrieved in the majority of cases using a variety of retrieval techniques, yet stent loss is associated with an increased risk of complications. Stent deployment or crushing may be a good alternative to retrieval.
我们的目标是研究经皮冠状动脉介入治疗（PCI）期间支架丢失的发生率、后果以及所采用的取出技术。我们回顾性分析了1994年1月至2004年3月在我院连续进行的11773例涉及支架的PCI病例，以确定支架丢失的病例。在11773例涉及支架的PCI手术中，有38例发生支架丢失（0.32%；95%可信区间=0.23 - 0.44%）。患者的平均年龄为67±11岁，82%为男性。支架丢失在伴有钙化和/或显著近端成角的病变中更常见。在3例患者中，支架被挤压并被另一个支架覆盖，未尝试取出。38例中有35例尝试取出支架，30例成功（86%）。采用了以下取出方法（有些病例使用了不止一种方法）：将球囊推进穿过支架、充盈球囊并取出支架（45%）；在支架周围缠绕两根导丝（5%）；圈套器（26%）；胆道钳（12%）；Cook保留碎片取出器（10%）；以及网篮取出装置（2%）。发生支架丢失的患者输血相关出血的发生率更高（24%对7%；P<0.001），且更常需要紧急冠状动脉旁路移植术（5%对0.4%；P<0.001）。支架被挤压或植入冠状动脉的患者均未出现任何严重心脏并发症。PCI期间支架丢失很少见。在大多数情况下，使用多种取出技术可以成功取出丢失的支架，但支架丢失与并发症风险增加有关。支架植入或挤压可能是取出之外的一个好选择。
