Escudero X, Van Belle E, McFadden E P, Lablanche J M, Bertrand M E
Servicio de Cardiología B y Hemodinámica, Hospital Cardiológico Universitario de Lille, Francia.
Arch Inst Cardiol Mex. 1995 Sep-Oct;65(5):413-9.
Acute coronary occlusion as a consequence of dissection or thrombosis occurs in 2 to 11% of patients treated with percutaneous transluminal coronary angioplasty (PTCA), and continues to be the principal cause of early morbidity and mortality. In this study the experience of one center is presented with the application of two types of stents, Wiktor (Medtronic Inc.) or Gianturco-Roubin (Cook Inc.) for bailout of acute or threatening coronary occlusion that persisted after treatment with prolonged balloon inflation. All patients received a complete anticoagulation scheme with heparin, dextran, dipyridamole, aspirin and coumadin. From January to November 1993, 26 patients with 27 prosthesis were included. There were 21 men and 5 women with mean age of 58 years (range 36 to 73). The indications for stenting were: total occlusion in five (19%) threatening occlusion in 13 (50%) and severe persistent dissection in eight (31%). Initial implantation success was 93% (25/27). Procedure related clinical complications were death in one patient, bypass surgery in two (8%) and myocardial infarction in four (15%). Acute stent thrombosis occurred in three cases and subacute in one (11 and 4% respectively). Three patients, had non-fatal bleeding complications. Final clinical success without myocardial infarction, bypass surgery or death was 77%. In conclusion, coronary stenting for bailout of acute or threatening coronary occlusion after PTCA is a good alternative to emergency surgery. New antithrombotic strategies and better anticoagulation schemes may improve further this procedure.
经皮腔内冠状动脉成形术（PTCA）治疗的患者中，2%至11%会因夹层或血栓形成导致急性冠状动脉闭塞，这仍是早期发病和死亡的主要原因。本研究介绍了一个中心应用两种类型支架（Wiktor支架，美敦力公司生产；Gianturco-Roubin支架，库克公司生产）对经长时间球囊扩张治疗后仍存在的急性或有威胁的冠状动脉闭塞进行补救的经验。所有患者均接受了包括肝素、右旋糖酐、双嘧达莫、阿司匹林和香豆素的完整抗凝方案。1993年1月至11月，纳入了26例患者的27个支架。其中男性21例，女性5例，平均年龄58岁（范围36至73岁）。置入支架的指征为：完全闭塞5例（19%），有威胁的闭塞13例（50%），严重持续性夹层8例（31%）。初始植入成功率为93%（25/27）。与手术相关的临床并发症包括1例死亡、2例（8%）行搭桥手术和4例（15%）发生心肌梗死。3例发生急性支架血栓形成，1例（分别为11%和4%）发生亚急性支架血栓形成。3例患者出现非致命性出血并发症。无心肌梗死、搭桥手术或死亡的最终临床成功率为77%。总之，PTCA后对急性或有威胁的冠状动脉闭塞进行冠状动脉支架置入是紧急手术的良好替代方案。新的抗血栓策略和更好的抗凝方案可能会进一步改善这一手术。
