Nakamura S, Hall P, Gaglione A, Tiecco F, Di Maggio M, Maiello L, Martini G, Colombo A
Ohta General Hospital, Division of Cardiology, Japan.
J Am Coll Cardiol. 1997 Jan;29(1):21-7. doi: 10.1016/s0735-1097(96)00431-7.
The purpose of this study was to determine the efficacy of treatment with antiplatelet therapy and no anticoagulation after high pressure assisted coronary stent implantation performed without intravascular ultrasound (IVUS) guidance.
Previous studies have shown that during IVUS-guided Palmaz-Schatz coronary stenting, it is safe to withhold anticoagulation when stent expansion has been optimized by high pressure balloon dilation.
Patients that had successful coronary stenting without IVUS guidance were treated with ticlopidine, 500 mg/day, and aspirin, 325 mg/day, for 1 month and then received only aspirin, 325 mg/day, indefinitely. Patients were not treated with warfarin (Coumadin) or heparin after successful stenting. Clinical and angiographic events were assessed at 1 month.
A total of 201 intracoronary stents were implanted in 127 patients with 137 lesions. The average number of stents per lesion was 1.4 +/- 0.8, and the average number of stents per patient was 1.6 +/- 1.1. Stent deployment was performed for elective indications in 79% of procedures and for emergency indications in 21%. There were four stent thrombosis events for a per patient event rate of 3.1% and a per lesion event rate of 2.9%.
After high pressure assisted stenting performed without IVUS guidance, there was an acceptable incidence of 3.1% of stent thrombosis with the combination of short-term ticlopidine and aspirin therapy and no anticoagulation. Although the study involved only 127 patients, the results support the relative safety of stenting without IVUS guidance and with antiplatelet therapy only in comparison to historical trials on stenting performed with postprocedure anticoagulation.
本研究旨在确定在无血管内超声（IVUS）引导下进行高压辅助冠状动脉支架植入术后，抗血小板治疗且不进行抗凝治疗的疗效。
先前的研究表明，在IVUS引导的Palmaz-Schatz冠状动脉支架置入术中，当通过高压球囊扩张使支架扩张达到最佳状态时，停用抗凝治疗是安全的。
在无IVUS引导下成功进行冠状动脉支架置入术的患者，先接受噻氯匹定500mg/天和阿司匹林325mg/天治疗1个月，然后无限期仅接受阿司匹林325mg/天治疗。成功置入支架后，患者不接受华法林（香豆素）或肝素治疗。在1个月时评估临床和血管造影事件。
127例患者共植入201个冠状动脉支架，有137处病变。每处病变支架的平均数量为1.4±0.8个，每位患者支架的平均数量为1.6±1.1个。79%的手术是为择期适应证进行支架置入，21%是为急诊适应证进行。有4例支架血栓形成事件，患者事件发生率为3.1%，病变事件发生率为2.9%。
在无IVUS引导下进行高压辅助支架置入术后，短期噻氯匹定和阿司匹林联合治疗且不进行抗凝治疗时，支架血栓形成的发生率为3.1%，这一发生率是可接受的。尽管该研究仅涉及127例患者，但与既往有术后抗凝治疗的支架置入试验相比，结果支持了无IVUS引导且仅采用抗血小板治疗进行支架置入的相对安全性。
