Berenguer Alberto, Mainar Vicente, Bordes Pascual, Valencia Jose, Gómez Silvia, Lozano Teresa
Cardiology Service, General Hospital of Alicante, Spain.
Am Heart J. 2005 Sep;150(3):536-42. doi: 10.1016/j.ahj.2004.10.009.
Sirolimus-eluting stents (SESs) have not been evaluated systematically in clinical scenarios or with the vascular morphologies associated with the highest rates of restenosis.
Between May 2002 and August 2003, 1379 percutaneous interventions were carried out at our center, 231 with SES implantation in patients with complex coronary lesions: (1) left main trunk, (2) bifurcations, (3) long lesions, (4) calcified lesions, (5) proximal segment of the left anterior descending coronary, (6) restenotic lesions, (7) total occlusions, (8) ostial lesions, and (9) vessels < 2.75 mm. Angiographic follow-up was carried out in the 6th month in 201 patients. Clinical, angiographic, and procedural variables were analyzed to assess predictors of restenosis.
Of the patients, 42.6% were diabetic and 20.2% were insulin dependent. A total of 263 lesions was treated. Mean lesion length was 16.5 +/- 11 mm and mean vessel diameter was 2.54 +/- 0.7 mm. A total of 327 stents was implanted to fully cover the entire lesion, in most cases after predilatation (89.1%). The mean segment length covered by the stent was 26 +/- 12 mm and the stent length/lesion length ratio was 1.7 +/- 0.9. Binary restenosis was found in 8.7%, but there was no edge restenosis. The only predictors of restenosis were female sex (OR 3.44, 95% CI 1.31-8.99, P = .011) and lesion length > 30 mm (OR 3.39, 95% CI 1.07-10.77, P = .038).
In scenarios that usually entail high restenotic risk in patients with conventional stent implantation, SESs had a low incidence of restenosis without edge complications.
西罗莫司洗脱支架（SESs）尚未在临床场景或与再狭窄率最高相关的血管形态中进行系统评估。
2002年5月至2003年8月期间，在我们中心进行了1379例经皮介入治疗，其中231例为在患有复杂冠状动脉病变的患者中植入SES，这些病变包括：（1）左主干；（2）分叉病变；（3）长病变；（4）钙化病变；（5）左前降支冠状动脉近端节段；（6）再狭窄病变；（7）完全闭塞病变；（8）开口病变；（9）血管直径<2.75mm。对201例患者在第6个月进行了血管造影随访。分析临床、血管造影和手术变量以评估再狭窄的预测因素。
患者中，42.6%为糖尿病患者，20.2%为胰岛素依赖型。共治疗263处病变。平均病变长度为16.5±11mm，平均血管直径为2.54±0.7mm。共植入327枚支架以完全覆盖整个病变，大多数情况下在预扩张后（89.1%）。支架覆盖的平均节段长度为26±12mm，支架长度/病变长度比为1.7±0.9。发现二元再狭窄率为8.7%，但无边缘再狭窄。再狭窄的唯一预测因素为女性（比值比3.44，95%可信区间1.31 - 8.99，P = 0.011）和病变长度>30mm（比值比3.39，95%可信区间1.07 - 10.77，P = 0.038）。
在常规支架植入患者中通常具有高再狭窄风险的情况下，SESs的再狭窄发生率较低且无边缘并发症。
