Barlis Peter, Kaplan Sahin, Dimopoulos Konstantinos, Ferrante Giuseppe, Di Mario Carlo
Royal Brompton Hospital, London, UK.
Cardiology. 2008;111(4):270-6. doi: 10.1159/000128602. Epub 2008 May 2.
Aorto-ostial lesions (AOL) are technically challenging, given their greater propensity to be calcific and associated with elastic recoil compared to non-ostial lesions. This study set out to assess angiographic and clinical outcomes in patients with AOL treated using either paclitaxel-eluting stents (PES) or sirolimus-eluting stents (SES) compared to bare-metal stent (BMS) implantation.
We retrospectively identified 175 consecutive patients with 175 AOL involving the left main, right coronary artery or bypass graft. PES, SES and BMS were implanted in 69, 50 and 56 patients, respectively.
Angiographic and procedural success was 100 and 97.1% for PES, 100 and 94% for SES, and 100 and 94.6% for BMS, respectively (p not significant). At 12 months, the rates of target lesion (8.7% for PES, 4.0% for SES) and target vessel revascularization (3.0% for PES, 8.0% for SES) were significantly lower in the drug-eluting stent group compared to BMS (32.1 and 35.7%, respectively). There was no difference in the rate of death/MI in the BMS versus drug-eluting stent groups (5.4 vs. 2.4%, p = 0.32).
In the treatment of AOL, drug-eluting stents reduce the need for repeat revascularization at 12 month follow-up compared to BMS, with no difference in mortality or MI rate.
主动脉开口处病变（AOL）在技术上具有挑战性，因为与非开口处病变相比，其钙化倾向更大且与弹性回缩有关。本研究旨在评估与裸金属支架（BMS）植入相比，使用紫杉醇洗脱支架（PES）或西罗莫司洗脱支架（SES）治疗的AOL患者的血管造影和临床结果。
我们回顾性确定了175例连续患者，其175处AOL累及左主干、右冠状动脉或旁路移植血管。分别有69、50和56例患者植入了PES、SES和BMS。
PES的血管造影和手术成功率分别为100%和97.1%，SES为100%和94%，BMS为100%和94.6%（p无统计学意义）。在12个月时，药物洗脱支架组的靶病变（PES为8.7%，SES为4.0%）和靶血管血运重建率（PES为3.0%，SES为8.0%）显著低于BMS组（分别为32.1%和35.7%）。BMS组与药物洗脱支架组的死亡/心肌梗死发生率无差异（5.4%对2.4%，p = 0.32）。
在AOL的治疗中，与BMS相比，药物洗脱支架在12个月随访时减少了重复血运重建的需求，死亡率或心肌梗死发生率无差异。
