使用自膨胀式和球囊扩张式内置假体进行动脉支架置入术。

Arterial stenting with self-expandable and balloon-expandable endoprostheses.

作者信息

van der Giessen W J, Serruys P W, van Woerkens L J, Beatt K J, Visser W J, Jongkind J F, van Bremen R H, Ridderhof E, van Loon H, Soei L K

机构信息

Department of Cardiology, Thoraxcenter, The Netherlands.

出版信息

Int J Card Imaging. 1990;5(2-3):163-71. doi: 10.1007/BF01833985.

DOI:10.1007/BF01833985

PMID:2230294

Abstract

Coronary angioplasty is complicated by acute occlusion (within 24 hours) and late restenosis (within 6 months) in 2-5% and 20-40% of the cases, respectively. Vascular endoprostheses (stents) may provide the cardiologist with a solution to some of these complications. Several stent-devices are now available for experimental and clinical evaluation. In this study we describe our experience with two metallic stents in normal arteries of swine. Self-expandable, stainless steel stents (3.5 mm diameter) were implanted in 17 peripheral arteries, eight of which were deendothelialized by prior balloon angioplasty. Following implantation, the animals received antithrombotic therapy with acenocoumarol and aspirin (8 stents), or aspirin alone (9 stents). After 1 week repeat angiography was performed, which showed patency of all stented arteries. Microscopy showed complete covering by neointima, 80 microns in thickness. This self-expandable stent (SES) and a balloon-expandable stent (BES), constructed of tantalum, were implanted in normal coronary arteries. SES (3.0 and 3.5 mm) receiving animals were treated with coumadines (10 stents) or received no antithrombotic treatment (16 stents) after implantation. BES receiving animals were also not treated (10 stents). Three untreated animals with SES died suddenly within 48 hours. Postmortem examination showed partial or complete thrombosis of all six stents in these animals, resulting in a patency rate of 62% after 1 week. All animals with SES, which were treated with coumadines, and all animals with BES (untreated) had patent stents after one week. It is concluded that SES implanted in normal coronary arteries of pigs, which do not receive additional antithrombotic treatment, show a 38% occlusion rate within 48 hours, but show 100% patency after 1 week, when the animals are treated with coumadines. BES implanted in normal coronary arteries of pigs, which do not receive antithrombotic drugs, are 100% patent after 1 week.

摘要

冠状动脉血管成形术分别有2% - 5%和20% - 40%的病例会并发急性闭塞（24小时内）和晚期再狭窄（6个月内）。血管内假体（支架）或许能为心脏病专家解决其中一些并发症提供办法。现在有几种支架装置可供进行实验和临床评估。在本研究中，我们描述了在猪的正常动脉中使用两种金属支架的经验。将可自膨胀的不锈钢支架（直径3.5毫米）植入17条外周动脉，其中8条动脉预先通过球囊血管成形术进行了去内皮处理。植入后，动物接受了醋硝香豆素和阿司匹林的抗血栓治疗（8个支架），或仅接受阿司匹林治疗（9个支架）。1周后进行重复血管造影，结果显示所有植入支架的动脉均通畅。显微镜检查显示新生内膜完全覆盖，厚度为80微米。这种可自膨胀支架（SES）和一种由钽制成的球囊扩张支架（BES）被植入正常冠状动脉。植入SES（3.0和3.5毫米）的动物在植入后接受香豆素类药物治疗（10个支架）或未接受抗血栓治疗（16个支架）。接受BES的动物也未接受治疗（10个支架）。3只未接受治疗的植入SES的动物在48小时内突然死亡。尸检显示这些动物的所有6个支架均出现部分或完全血栓形成，1周后的通畅率为62%。所有接受香豆素类药物治疗的植入SES的动物以及所有植入BES（未治疗）的动物在1周后支架均通畅。得出的结论是：植入猪正常冠状动脉且未接受额外抗血栓治疗的SES，在48小时内闭塞率为38%，但当动物接受香豆素类药物治疗时，1周后通畅率为100%。植入猪正常冠状动脉且未接受抗血栓药物治疗的BES，1周后通畅率为100%。