Colombo A, Goldberg S L, Almagor Y, Maiello L, Finci L
Centro Cuore Columbus, Milan, Italy.
J Am Coll Cardiol. 1993 Dec;22(7):1887-91. doi: 10.1016/0735-1097(93)90774-u.
The purpose of this study was to determine the immediate and long-term angiographic and clinical results of coronary stenting as a specific therapy for intracoronary dissection associated with acute or threatened closure complicating percutaneous transluminal coronary angioplasty.
Published reports contain conflicting results with regard to the benefit of stent insertion for coronary dissection. In particular, there is a wide range in the reported rates of subacute occlusion.
Palmaz-Schatz stents were inserted in 56 patients who had significant dissections and acute or threatened closure complicating coronary angioplasty. An attempt was made to cover the entire site of the dissection with short or standard single or multiple Palmaz-Schatz stents. The use of the short stent allowed complete coverage of the dissection, specifically in situations such as marked vessel tortuosity or the need to place a stent distal to a deployed stent.
A single stent was implanted in 24 patients and multiple stents were implanted in 32 patients. A total of 138 stents (78 standard, 60 short stents) were implanted. The primary clinical success rate was 88% (49 of 56 patients). Complications occurred in seven patients (12.5%): Three patients (5%) required urgent bypass surgery; two patients (4%) had a myocardial infarction; and two patients (4%) died. Subacute occlusion occurred in one patient (2%). Clinical follow-up was available in all patients at a mean of 10 +/- 4 months. Thirty-nine (80%) of 49 patients were clinically asymptomatic. Angiographic restenosis was found in 15 (36%) of 42 patients on angiographic follow-up performed a mean of 5 months (median 6) after the procedure in 86% of the eligible patients. Nine patients had successful repeat angioplasty, and two had elective bypass surgery.
The strategy of coronary stenting to completely cover the lesion is an effective treatment for large coronary dissection complicating angioplasty. A total major complication rate of 12.5% may be acceptable for this high risk group.
本研究旨在确定冠状动脉支架置入术作为经皮冠状动脉腔内血管成形术（PTCA）相关急性或濒临闭塞性冠状动脉夹层的一种特异性治疗方法的即刻和长期血管造影及临床结果。
关于冠状动脉夹层支架置入术的益处，已发表的报告结果相互矛盾。特别是，所报道的亚急性闭塞发生率差异很大。
对56例冠状动脉血管成形术并发严重夹层及急性或濒临闭塞的患者置入Palmaz-Schatz支架。尝试用短的或标准的单个或多个Palmaz-Schatz支架覆盖整个夹层部位。使用短支架可完全覆盖夹层，特别是在血管明显迂曲或需要在已置入支架的远端再置入支架的情况下。
24例患者置入单个支架，32例患者置入多个支架。共置入138个支架（78个标准支架，60个短支架）。主要临床成功率为88%（56例患者中的49例）。7例患者（12.5%）出现并发症：3例患者（5%）需要紧急搭桥手术；2例患者（4%）发生心肌梗死；2例患者（4%）死亡。1例患者（2%）发生亚急性闭塞。所有患者均获得临床随访，平均随访时间为10±4个月。49例患者中有39例（80%）临床无症状。在术后平均5个月（中位数6个月）对86%的符合条件患者进行血管造影随访时，42例患者中有15例（36%）发现血管造影再狭窄。9例患者成功进行了再次血管成形术，2例患者接受了择期搭桥手术。
冠状动脉支架置入术完全覆盖病变的策略是治疗血管成形术相关大型冠状动脉夹层的有效方法。对于这个高危组，12.5%的总主要并发症发生率可能是可以接受的。
