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透析患者冠状动脉疾病的药物洗脱支架置入策略

The stenting strategy of drug-eluting stents for coronary artery disease in patients on dialysis.

作者信息

Fujita Hiroshi, Nasu Kenya, Terashima Mitsuyasu, Ito Tsuyoshi, Tani Tomomitsu, Suzuki Takahiko, Ohte Nobuyuki

机构信息

Department of Cardio-Renal Medicine and Hypertension, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.

Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan.

出版信息

SAGE Open Med. 2014 Dec 16;2:2050312114562395. doi: 10.1177/2050312114562395. eCollection 2014.

Abstract

BACKGROUND

Reports regarding the relationship between the length and diameter of implanted drug-eluting stents and clinical and angiographic outcomes in dialysis patients are limited.

AIM

We investigated the efficiency of drug-eluting stents for coronary artery disease in patients on dialysis from the viewpoint of stent sizing.

METHODS

Sirolimus-eluting stents were implanted in 88 lesions and bare metal stents were implanted in 43 lesions. We compared stenting strategy, major adverse cardiac events, and angiographic results between sirolimus-eluting stent and bare metal stent groups.

RESULTS

Stent diameter was smaller and stent length was longer in the sirolimus-eluting stent group than in the bare metal stent group in our routine practices. There was no significant between-group difference in late diameter loss. Rates of angiographic restenosis and target lesion revascularization were significantly higher in the sirolimus-eluting stent group than in the bare metal stent group. Although stent length was significantly longer and stent diameter was smaller in the sirolimus-eluting stent group, sirolimus-eluting stents did not improve the subsequent clinical and angiographic results compared with bare metal stents in dialysis patients.

CONCLUSION

In dialysis patients, a longer length and/or smaller diameter sirolimus-eluting stent implantation was associated with high rates of restenosis and target lesion revascularization compared with bare metal stents.

摘要

背景

关于植入药物洗脱支架的长度和直径与透析患者临床及血管造影结果之间关系的报道有限。

目的

我们从支架尺寸的角度研究了药物洗脱支架治疗透析患者冠状动脉疾病的有效性。

方法

88处病变植入西罗莫司洗脱支架,43处病变植入裸金属支架。我们比较了西罗莫司洗脱支架组和裸金属支架组的支架置入策略、主要不良心脏事件及血管造影结果。

结果

在我们的常规操作中,西罗莫司洗脱支架组的支架直径较小且支架长度较长。两组之间晚期管腔丢失无显著差异。西罗莫司洗脱支架组的血管造影再狭窄率和靶病变血运重建率显著高于裸金属支架组。尽管西罗莫司洗脱支架组的支架长度明显更长且支架直径更小,但与裸金属支架相比,西罗莫司洗脱支架并未改善透析患者随后的临床及血管造影结果。

结论

在透析患者中,与裸金属支架相比,植入长度更长和/或直径更小的西罗莫司洗脱支架与更高的再狭窄率和靶病变血运重建率相关。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9647/4712748/22735eedd872/10.1177_2050312114562395-fig1.jpg

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