Fischman D L, Savage M P, Leon M B, Schatz R A, Ellis S G, Cleman M W, Teirstein P, Walker C M, Bailey S, Hirshfeld J W
Department of Medicine, Jefferson Medical College, Philadelphia.
J Am Coll Cardiol. 1991 Nov 15;18(6):1445-51. doi: 10.1016/0735-1097(91)90673-w.
The effect of the Palmaz-Schatz stent on the angiographic appearance and residual luminal stenosis in patients with intimal dissection after balloon angioplasty was evaluated in 84 consecutive patients (90 lesions). Coronary angiography was performed before angioplasty, after conventional angioplasty and after stent implantation. The degree of intimal disruption was assessed as follows: grade 0, no dissection; grade 1, simple dissection (intraluminal linear defect or extraluminal cap extravasation); or grade 2, complex dissection (nonlinear spiral defect or luminal defect with multiple irregular borders). Quantitative coronary analysis of digitized cineangiograms was performed with use of a computerized automatic edge detection algorithm. After balloon angioplasty, 31 (34%) of 90 lesions demonstrated intimal dissection (18 simple, 13 complex). After stent implantation, intimal dissection improved by greater than or equal to 1 grade in 29 (94%) of the 31 lesions with 27 (87%) reduced to grade 0 (that is, no dissection). Dissection grade improved after stenting in 16 (89%) of 18 simple dissections and in all 13 complex dissections. Mean diameter stenosis was 77 +/- 17% before angioplasty, 47 +/- 17% after angioplasty and 14 +/- 10% after stenting (before angioplasty vs. after angioplasty and after angioplasty vs. after stenting, p less than 0.0001). In conclusion, intracoronary stenting is effective in reducing the residual luminal stenosis and in improving the angiographic appearance of intimal dissections after conventional balloon angioplasty.
对84例连续患者（90处病变）评估了Palmaz-Schatz支架对球囊血管成形术后内膜夹层患者血管造影表现及残余管腔狭窄的影响。在血管成形术前、传统血管成形术后及支架植入后均进行了冠状动脉造影。内膜撕裂程度评估如下：0级，无夹层；1级，单纯夹层（腔内线性缺损或腔外帽状外渗）；或2级，复杂夹层（非线性螺旋状缺损或具有多个不规则边界的管腔缺损）。使用计算机自动边缘检测算法对数字化电影血管造影进行定量冠状动脉分析。球囊血管成形术后，90处病变中有31处（34%）出现内膜夹层（18处单纯性，13处复杂性）。支架植入后，31处有内膜夹层的病变中，29处（94%）内膜夹层改善≥1级，其中27处（87%）降至0级（即无夹层）。18处单纯性夹层中的16处（89%）及所有13处复杂性夹层在支架置入后夹层分级均有改善。血管成形术前平均直径狭窄为77±17%，血管成形术后为47±17%，支架植入后为14±10%（血管成形术前与血管成形术后以及血管成形术后与支架植入后比较，p<0.0001）。总之，冠状动脉内支架置入术可有效减少传统球囊血管成形术后的残余管腔狭窄，并改善内膜夹层的血管造影表现。
