经皮腔内冠状动脉成形术期间夹层的紧急冠状动脉支架置入术：支架置入后及支架段重复血管成形术后的血管造影随访

Emergency coronary stenting for dissection during percutaneous transluminal coronary angioplasty: angiographic follow-up after stenting and after repeat angioplasty of the stented segment.

作者信息

Schömig A, Kastrati A, Dietz R, Rauch B, Neumann F J, Katus H H, Busch U

机构信息

I. Medizinische Klinik, Technischen Universität München, Germany.

出版信息

J Am Coll Cardiol. 1994 Apr;23(5):1053-60. doi: 10.1016/0735-1097(94)90589-4.

DOI:10.1016/0735-1097(94)90589-4

PMID:8144767

Abstract

OBJECTIVES

The purpose of this study was to assess the angiographic results after emergency coronary stenting and after repeat angioplasty for restenosis within the stent.

BACKGROUND

There is still little angiographic information about lumen renarrowing and its correlates after emergency stenting, and data with regard to the angiographic outcome of repeat angioplasty within the stent are almost nonexistent.

METHODS

This study was based on the quantitative evaluation of angiograms performed before and immediately after intervention and at 6-month follow-up. The study included 164 of the 183 eligible patients with emergency Palmaz-Schatz stent implantation and 31 of those with restenosis within the stent who had repeat angioplasty.

RESULTS

Stenting produced an improvement in minimal lumen diameter from 0.82 +/- 0.41 to 2.76 +/- 0.47 mm (mean +/- SD) and in diameter stenosis from 74.9 +/- 11.5% to 18.3 +/- 8.1%. Elastic recoil was 0.51 +/- 0.34 mm, or 16%. At 6-month follow-up, 32.3% of the patients had restenosis (> or = 50% stenosis). Minimal lumen diameter decreased to 1.84 +/- 0.78 mm, and diameter stenosis increased to 41.7 +/- 21.0%. The degree of lumen loss correlated significantly with the length of the original stenosis and the initial lumen gain achieved by stenting. Thirty-one patients with in-stent restenosis underwent repeat angioplasty. The primary success rate was 100%, and no abrupt vessel closure was verified. Minimal lumen diameter increased from 0.85 +/- 0.35 to 2.18 +/- 0.39 mm, and diameter stenosis decreased from 69.7 +/- 12.9% to 28.6 +/- 9.4%. Elastic recoil was 0.82 +/- 0.38 mm, or 27%. At follow-up, 38.5% of the patients had restenosis. Minimal lumen diameter was reduced to 1.72 +/- 0.67 mm, and diameter stenosis increased to 42.4 +/- 18.1%.

CONCLUSIONS

Angiographic results of emergency coronary stenting compare favorably with those of conventional angioplasty. In-stent balloon redilation in patients with restenosis is associated with excellent short-term results and a restenosis rate not different from that reported for nonstented vessels.

摘要

目的

本研究旨在评估急诊冠状动脉支架置入术后以及支架内再狭窄行再次血管成形术后的血管造影结果。

背景

关于急诊支架置入术后管腔再狭窄及其相关因素的血管造影信息仍然很少，而且几乎不存在关于支架内再次血管成形术血管造影结果的数据。

方法

本研究基于对干预前、干预后即刻以及6个月随访时所行血管造影的定量评估。该研究纳入了183例符合条件的行急诊Palmaz-Schatz支架置入术患者中的164例，以及31例支架内再狭窄且接受再次血管成形术的患者。

结果

支架置入使最小管腔直径从0.82±0.41mm改善至2.76±0.47mm（均值±标准差），直径狭窄从74.9±11.5%降至18.3±8.1%。弹性回缩为0.51±0.34mm，即16%。在6个月随访时，32.3%的患者出现再狭窄（狭窄≥50%）。最小管腔直径降至1.84±0.78mm，直径狭窄增至41.7±21.0%。管腔丢失程度与原狭窄长度以及支架置入后最初获得的管腔增加量显著相关。31例支架内再狭窄患者接受了再次血管成形术。主要成功率为100%，未证实有血管突然闭塞。最小管腔直径从0.85±0.35mm增至2.18±0.39mm，直径狭窄从69.7±12.9%降至28.6±9.4%。弹性回缩为0.82±0.38mm，即27%。在随访时，38.5%的患者出现再狭窄。最小管腔直径降至1.72±0.67mm，直径狭窄增至42.4±18.1%。