Gambhir D S, Trehan V, Rastogi P, Sethi K K, Arora R, Kaul U A, Khanna S K
Department of Cardiology, GB Pant Hospital, New Delhi.
Indian Heart J. 1996 Jan-Feb;48(1):53-8.
From January to December 1995, 73 out of 174 patients with coronary artery disease underwent elective stenting for type B and C lesions. The age ranged from 35 to 73 years (mean +/- SD : 52.1 +/- 12.6) and the majority (91.7%) were males. Of the 74 vessels treated, the target vessel was LAD in 49 (66.4%), LCx in 13 (17.6%), RCA in 8 (10.8%) and SVG in 4 (5.2%). Based upon the ACC/AHA task force classification, 58 (79.5%) patients had type B1, 9 (12.3%) B2 and 6 (8.2%) had type C lesions. A total of 89 stents were deployed to treat 76 lesions with a range of 1 to 3 stents per lesion. A single stent was required for 67 lesions, 2 stents for 8 and 3 stents for 2 lesions. The stents used were Wiktor (29), Palmaz-Schatz (26), Gianturco-Roubin (24), Microstent (6) and Freedom (4), depending upon the anatomical and morphological characteristics with the lesion. Using high pressure strategy, the stents were deployed successfully in all (100%) with a reduction in luminal diameter stenosis from 92 +/- 5.4 to -5 +/- 6 percent. There was no subacute stent thrombosis despite nonusability of oral anticoagulation in 95.9 percent patients. None had any major complication in the form of acute myocardial infarction, need for emergency bypass graft surgery or death. Minor complications were encountered in 9 (12.3%) patients. At a mean follow-up of 26 +/- 14 weeks, 74 percent of the patients were asymptomatic. Out of 31 patients who had completed 6 months after the procedure, repeat angiography was performed in 29 (93.5%) at a mean duration of 29 +/- 6 weeks. The angiographic restenosis was found in 6 (20.7%) patients. In conclusion, type B and C lesions can be treated successfully using elective stenting with excellent immediate results and clinical outcome. Angiographic restenosis, which develops in about one-fifth of patients, appears to be much lower than reported after balloon angioplasty for these complex lesions.
1995年1月至12月，174例冠心病患者中有73例因B型和C型病变接受了择期支架置入术。年龄范围为35至73岁（平均±标准差：52.1±12.6），大多数（91.7%）为男性。在治疗的74支血管中，靶血管为左前降支（LAD）49支（66.4%），左旋支（LCx）13支（17.6%），右冠状动脉（RCA）8支（10.8%），大隐静脉桥血管（SVG）4支（5.2%）。根据美国心脏病学会/美国心脏协会（ACC/AHA）工作组分类，58例（79.5%）患者为B1型，9例（12.3%）为B2型，6例（8.2%）为C型病变。共置入89枚支架以治疗76处病变，每处病变置入支架数量为1至3枚。67处病变需要单枚支架，8处需要2枚支架，2处需要3枚支架。根据病变的解剖和形态特征，使用的支架有Wiktor（29枚）、Palmaz-Schatz（26枚）、Gianturco-Roubin（24枚）、Microstent（6枚）和Freedom（4枚）。采用高压策略，所有支架均成功置入（100%），管腔直径狭窄率从92±5.4%降至-5±6%。尽管95.9%的患者未使用口服抗凝药，但未发生亚急性支架血栓形成。无一例发生急性心肌梗死、急诊冠状动脉搭桥手术或死亡等严重并发症。9例（12.3%）患者出现轻微并发症。平均随访26±14周时，74%的患者无症状。在31例术后已完成6个月的患者中，29例（93.5%）在平均29±6周时进行了再次血管造影。6例（20.7%）患者发现血管造影显示的再狭窄。总之，B型和C型病变可通过择期支架置入术成功治疗，即刻效果和临床结局良好。血管造影显示的再狭窄发生率约为五分之一，似乎远低于针对这些复杂病变进行球囊血管成形术后的报道。
