Wiebe Jens, Dörr Oliver, Liebetrau Christoph, Bauer Timm, Wilkens Eva, Ilstad Hanna, Boeder Niklas, Elsässer Albrecht, Möllmann Helge, Hamm Christian W, Nef Holger M
Department of Cardiology, University of Giessen, Medizinische Klinik I, Giessen, Germany; Deutsches Herzzentrum München, Munich, Germany.
Department of Cardiology, University of Giessen, Medizinische Klinik I, Giessen, Germany.
Rev Esp Cardiol (Engl Ed). 2016 Dec;69(12):1144-1151. doi: 10.1016/j.rec.2016.08.012. Epub 2016 Oct 27.
The implantation of bioresorbable scaffolds (BRS) is an emerging technique used in percutaneous coronary interventions. Their application has been extended to more complex lesions, although evidence is only available for simple lesions. The present study evaluated scaffold implantation in long lesions, focusing on overlapping scaffolds.
We retrospectively analyzed all consecutive patients eligible for stenting with everolimus-eluting poly-L-lactic acid-based BRS with a minimum total scaffold length of 28mm, irrespective of the number of BRS used. The main target parameters were major adverse cardiac events, comprising cardiac death, any myocardial infarction, and target lesion revascularization, and target lesion failure, including cardiac death, target vessel myocardial infarction, and target lesion revascularization. A subgroup analysis included patients with overlapping BRS.
A total of 250 patients were included. The reason for angiography was stable coronary artery disease in 36.4% (91 of 250), an acute coronary syndrome in 61.6% (154 of 250), and other reasons in 2.0% (5 of 250). Procedural success was achieved in 97.8% (267 of 273) of the lesions. During follow-up, the 12-month rates of major adverse cardiac event, target lesion failure, and scaffold thrombosis were 8.5%, 6.6%, and 2.3%, respectively. Subgroup analysis of 239 patients showed that there were no statistically relevant differences between patients with and without overlapping scaffolds after a 12-month follow-up.
Long-segment stenting with a single scaffold or with multiple overlapping scaffolds is technically feasible with adequate mid-term outcomes. However, large-scale randomized studies are needed to provide further proof of concept.
生物可吸收支架（BRS）植入术是经皮冠状动脉介入治疗中一项新兴技术。尽管目前仅有关于简单病变的证据，但该技术的应用已扩展至更复杂的病变。本研究评估了长病变中支架植入情况，重点关注重叠支架。
我们回顾性分析了所有连续入选的患者，这些患者使用基于聚左旋乳酸的依维莫司洗脱BRS进行支架植入，总支架长度至少为28mm，无论使用的BRS数量。主要目标参数为主要不良心脏事件，包括心源性死亡、任何心肌梗死和靶病变血运重建，以及靶病变失败，包括心源性死亡、靶血管心肌梗死和靶病变血运重建。亚组分析纳入了重叠BRS的患者。
共纳入250例患者。血管造影的原因是稳定型冠状动脉疾病占36.4%（250例中的91例），急性冠状动脉综合征占61.6%（250例中的154例），其他原因占2.0%（250例中的5例）。97.8%（273例中的267例）的病变手术成功。随访期间，主要不良心脏事件、靶病变失败和支架血栓形成的12个月发生率分别为8.5%、6.6%和2.3%。对239例患者的亚组分析显示，12个月随访后，有重叠支架和无重叠支架的患者之间无统计学显著差异。
单支架或多重叠支架的长节段支架植入术在技术上是可行的，中期结果良好。然而，需要大规模随机研究来提供进一步的概念验证。
