慢性完全闭塞病变球囊血管成形术后冠状动脉内支架置入术。

Intracoronary stent insertion after balloon angioplasty of chronic total occlusions.

作者信息

Goldberg S L, Colombo A, Maiello L, Borrione M, Finci L, Almagor Y

机构信息

Division of Cardiology, Harbor-UCLA Medical Center, Torrance 90509, USA.

出版信息

J Am Coll Cardiol. 1995 Sep;26(3):713-9. doi: 10.1016/0735-1097(95)00219-T.

DOI:10.1016/0735-1097(95)00219-T

PMID:7642864

Abstract

OBJECTIVES

This retrospective analysis was performed to assess the medium-term effectiveness of implanting intracoronary stents into chronic total occlusions that are successfully opened by balloon angioplasty.

BACKGROUND

The value of percutaneous transluminal coronary angioplasty of chronic total occlusions is limited by a very high restenosis rate of 50% to 68%. Intravascular stents have been shown to reduce restenosis in a subset of patients with subtotal stenoses. It has not been demonstrated that the placement of stents into successfully opened chronic total coronary artery occlusions leads to lower rates of restenosis.

METHODS

A consecutive series of patients with chronic total coronary occlusions successfully opened by balloon angioplasty received Palmaz-Schatz stents. Patients underwent clinical and angiographic follow-up at a mean of 6 months after stent insertion. Angiographic and clinical results were retrospectively analyzed.

RESULTS

Fifty-nine patients underwent stenting of 60 chronic total coronary occlusions, with a 98% rate of successful stent deployment. Complications occurred in 5% of cases, all with subacute thrombosis. Angiographic follow-up was obtained in 88% of patients at a mean of 6 months and demonstrated an angiographic restenosis rate of 20%, with only one reocclusion. Among several variables examined, only the presence of a procedure-related moderate to severe dissection was associated with higher follow-up percent diameter stenoses and clinical events. At a mean of 14 months after stent insertion, 77% of patients remained free of symptoms or clinical events.

CONCLUSIONS

The implantation of intracoronary stents into vessels with opened chronic total coronary occlusions is associated with favorable rates of angiographic restenosis and relief of symptoms. A randomized clinical trial comparing balloon angioplasty with stent-assisted balloon angioplasty in the treatment of chronic total coronary occlusions is indicated.

摘要

目的

进行这项回顾性分析以评估在经球囊血管成形术成功开通的慢性完全闭塞病变中植入冠状动脉支架的中期疗效。

背景

慢性完全闭塞病变的经皮腔内冠状动脉血管成形术的价值受到50%至68%的极高再狭窄率的限制。血管内支架已被证明可降低部分次全狭窄患者的再狭窄率。但尚未证实将支架置入成功开通的慢性冠状动脉完全闭塞病变中会降低再狭窄率。

方法

一系列经球囊血管成形术成功开通慢性冠状动脉完全闭塞病变的患者接受了帕尔马兹-施查茨支架植入。患者在支架置入后平均6个月接受临床和血管造影随访。对血管造影和临床结果进行回顾性分析。

结果

59例患者对60处慢性冠状动脉完全闭塞病变进行了支架置入，支架成功置入率为98%。5%的病例发生并发症，均为亚急性血栓形成。88%的患者在平均6个月时接受了血管造影随访，血管造影再狭窄率为20%，仅有1例再闭塞。在检查的几个变量中，只有与手术相关的中度至重度夹层与更高的随访管腔直径狭窄百分比和临床事件相关。在支架置入后平均14个月时，77%的患者无症状或无临床事件。