Gambhir D S, Sudha R, Trehan V, Jain R, Singh S, Kaul U A, Arora R
Department of Cardiology, GB Pant Hospital, New Delhi.
Indian Heart J. 1997 Jan-Feb;49(1):53-9.
Between April and December 1996, 50 less-shortening Wallstents were deployed in the native coronary arteries of 44 patients, with lesions more than 20 mm long and minimum vessel diameter of at least 3.0 mm. There were 39 males and 5 females with an age range of 35-77 years. The majority (70.4%) had multivessel disease (MVD). The target vessel was LAD for 17 (34%), RCA 23 (46%) and LCx-OM for 10 (20%) stents. All lesions were type C, according to the ACC/AHA Task Force Classification. The length of the lesions ranged from 21-60 mm (mean: 31 +/- 8). The stent selection was based upon oversizing by 1.5-2.0 mm compared to the minimum vessel diameter, and covering approximately 4-5 mm of the apparently normal vessel on either side of the target lesion. The stent was deployed successfully without any major complications, including myocardial infarction, emergency coronary artery bypass grafting (CABG) and death in 43 out of 44 (97.7%) patients. One patient in whom there was failure to reach the target site with stent, developed non-Q wave inferior myocardial infarction. Post-discharge, two patients reported to have died within one month after the procedure. The event-free survival, defined as the absence of angina, myocardial infarction, need for revascularisation or death was 93.2 percent at 30 days and 84 percent at 6 months following stent implantation. From our data, it is concluded that (i) the delivery of the new, less-shortening, self-expanding Wallstent at the target site was possible in almost all the cases; (ii) clinical success with < 30 percent residual diameter stenosis could be achieved in approximately 98 percent of cases, and (iii) there was an impressive event-free survival of 84 percent at 6 months of follow-up. The occurrence of 2 deaths during the first 30 days, however, necessitates close supervision for possible subacute stent thrombosis. The results of angiography after six months would help to define the true incidence of restenosis.
1996年4月至12月期间，在44例患者的自身冠状动脉中植入了50枚缩短较少的Wallstent支架，这些患者的病变长度超过20 mm，最小血管直径至少为3.0 mm。其中男性39例，女性5例，年龄范围为35 - 77岁。大多数患者（70.4%）患有多支血管病变（MVD）。植入支架的靶血管为左前降支（LAD）17枚（34%）、右冠状动脉（RCA）23枚（46%）、左旋支-钝缘支（LCx - OM）10枚（20%）。根据美国心脏病学会/美国心脏协会（ACC/AHA）工作组分类，所有病变均为C型。病变长度范围为21 - 60 mm（平均：31±8）。支架选择的依据是比最小血管直径大1.5 - 2.0 mm，并且覆盖靶病变两侧约4 - 5 mm的正常血管。44例患者中有43例（97.7%）成功植入支架，未发生任何严重并发症，包括心肌梗死、急诊冠状动脉旁路移植术（CABG）和死亡。1例患者支架未能到达靶部位，发生了非Q波下壁心肌梗死。出院后，2例患者在术后1个月内死亡。无事件生存率定义为无心绞痛、心肌梗死、血运重建需求或死亡，在支架植入后30天为93.2%，6个月时为84%。根据我们的数据得出以下结论：（i）几乎在所有情况下，都能够在靶部位植入新型、缩短较少的自膨胀Wallstent支架；（ii）约98%的病例能够实现残余直径狭窄< 30%的临床成功；（iii）随访6个月时，无事件生存率高达84%，令人印象深刻。然而，在最初30天内发生了2例死亡，因此有必要密切监测是否可能发生亚急性支架血栓形成。6个月后的血管造影结果将有助于确定再狭窄的真实发生率。
