Carey L, Cameron J, Aroney C, Bett N, Holt G, Mahononda N, McEniery P
Department of Cardiology, Prince Charles Hospital, Brisbane, Qld.
Aust N Z J Med. 1994 Feb;24(1):31-5. doi: 10.1111/j.1445-5994.1994.tb04422.x.
Emergency coronary artery bypass grafting (CABG) has previously been the only option in the treatment of refractory abrupt vessel closure complicating percutaneous transluminal coronary angioplasty (PTCA), and has been associated with high rates of morbidity and mortality. Intracoronary stenting now provides an alternative to emergency CABG.
To assess our initial experience with emergency coronary artery stenting as a new technique.
Retrospective case study review with clinical and angiographic follow-up.
The Gianturco-Roubin (GR) stent was deployed in 13 patients in whom PTCA was complicated by abrupt vessel closure refractory to standard balloon techniques. Indications for PTCA were unstable angina (six), stable angina (six) and acute myocardial infarction (MI) (one). The arteries stented included left anterior descending (LAD) artery lesions (eight) and right coronary artery lesions (five). Two patients required urgent CABG, one due to failed stent deployment and one for inadequate control of vessel dissection. In seven of the stented patients the creatine kinase rose to greater than twice the upper limit or normal. Three patients had subacute thrombotic occlusion at seven to 19 days post stent deployment, managed with intravenous thrombolysis or repeat PTCA. At seven months follow-up, 11 patients were free of angina, two patients had Canadian Heart Association class II angina and there were no deaths. Eleven patients had repeat angiography at mean six months post stent. Five patients had evidence of restenosis managed with repeat PTCA in four and CABG in one.
The GR stent is an effective alternative to urgent CABG in the treatment of refractory abrupt vessel closure complicating PTCA.
急诊冠状动脉旁路移植术（CABG）曾是治疗经皮腔内冠状动脉成形术（PTCA）并发的难治性血管突然闭塞的唯一选择，且与高发病率和死亡率相关。冠状动脉内支架置入术现在为急诊CABG提供了一种替代方法。
评估我们作为一项新技术进行急诊冠状动脉支架置入术的初步经验。
进行回顾性病例研究并进行临床和血管造影随访。
13例PTCA并发标准球囊技术难以处理的血管突然闭塞患者接受了朱安图尔科-鲁宾（GR）支架置入。PTCA的适应证包括不稳定型心绞痛（6例）、稳定型心绞痛（6例）和急性心肌梗死（MI）（1例）。置入支架的动脉包括左前降支（LAD）动脉病变（8例）和右冠状动脉病变（5例）。2例患者需要紧急CABG，1例是由于支架置入失败，1例是由于血管夹层控制不佳。7例置入支架的患者肌酸激酶升高至正常上限的两倍以上。3例患者在支架置入后7至19天发生亚急性血栓闭塞，通过静脉溶栓或重复PTCA进行处理。在7个月的随访中，11例患者无心绞痛，2例患者有加拿大心脏协会II级心绞痛，且无死亡病例。11例患者在支架置入后平均6个月进行了重复血管造影。5例患者有再狭窄证据，4例通过重复PTCA处理，1例通过CABG处理。
在治疗PTCA并发的难治性血管突然闭塞方面，GR支架是紧急CABG的有效替代方法。
