Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands.
Int J Cardiol. 2008 Oct 13;129(3):348-53. doi: 10.1016/j.ijcard.2007.08.018. Epub 2007 Nov 26.
Percutaneous treatment of stenoses involving aorto-ostial lesions is technically demanding and has been associated with lower procedural success and poorer clinical and angiographic outcomes when compared with non-ostial lesions. This study evaluated the immediate and long-term (2-year) outcome of aorto-ostial stenoses treated with paclitaxel-eluting stents (PES).
From February 2003 to December 2004, a total of 76 consecutive patients with 76 lesions underwent percutaneous intervention with PES for aorto-ostial lesions (right coronary artery, 37; left main, 26; saphenous vein graft, 13). All patients were clinically followed for the occurrence of major adverse cardiac events (MACE), defined as cardiac death, non-fatal myocardial infarction (MI), target lesion revascularization (TLR) or target vessel revascularization (TVR).
All stents (1.7/lesion) were successfully deployed. Three lesions (3.9%) were pre-treated with debulking devices. Thirty-seven lesions (48.7%) were post-dilated with non-compliant balloons (balloon/artery ratio, 1.2). Stents were positioned protruding into the aortic lumen in 29 lesions (38.2%). Cumulative 2-year event-free survival was 68.4%. There was one angiographically-proven stent thrombosis occurring 427 days after TLR for restenosis after the index procedure. The restenosis rate at 7 months (median) was 20.0% and in-stent late lumen loss was 0.48 mm in 40 patients with angiographic follow-up.
Utilization of PES in this complex lesion subset is feasible and associated with favorable angiographic results at 7 months. However, the gradual increase in later events up to 2 years suggests that aorto-ostial disease remains problematic even in the era of drug-eluting stents.
经皮治疗累及主动脉口的狭窄病变技术要求较高，与非口部病变相比，其手术成功率较低，临床和血管造影结果较差。本研究评估了紫杉醇洗脱支架（PES）治疗主动脉口狭窄的即刻和长期（2 年）结果。
2003 年 2 月至 2004 年 12 月，76 例连续患者的 76 处病变接受了 PES 经皮介入治疗主动脉口病变（右冠状动脉 37 例，左主干 26 例，大隐静脉桥 13 例）。所有患者均接受临床随访，以观察主要不良心脏事件（MACE）的发生情况，定义为心脏死亡、非致死性心肌梗死（MI）、靶病变血运重建（TLR）或靶血管血运重建（TVR）。
所有支架（1.7/病变）均成功植入。3 处病变（3.9%）采用减容装置预处理。37 处病变（48.7%）采用非顺应性球囊后扩张（球囊/动脉比为 1.2）。29 处病变（38.2%）支架突出于主动脉腔内。2 年累积无事件生存率为 68.4%。TLR 治疗后 427 天，有 1 例支架内血栓形成，为指数手术后再狭窄。7 个月（中位数）时的再狭窄率为 20.0%，40 例接受血管造影随访的患者中有支架内晚期管腔丢失 0.48 毫米。
在这一复杂病变亚组中使用 PES 是可行的，并且在 7 个月时具有良好的血管造影结果。然而，2 年内晚期事件逐渐增加表明，即使在药物洗脱支架时代，主动脉口病变仍然是一个问题。
