Maillard L, Paemelaere J M, Desveaux B, Quilliet L, Moini C, Hudelo C, Pacouret G, Charbonnier B, Raynaud P
Service de cardiologie A, CHU Trousseau, Tours.
Arch Mal Coeur Vaiss. 1997 Feb;90(2):253-61.
Between December 1991 and November 1994, a Palmaz-Schatz stent was implanted in 9 patients aged 57 +/- 14 years during the acute phase of myocardial infarction after primary angioplasty in 7 cases and salvage angioplasty in 2 cases after an interval of 175 mm +/- 62 mn from the onset of infarction, because of threatening dissection (N = 8) or a partial result (N = 1). The success rate of implantation was 100% with residual stenosis (DCI Philips system) measured at 16 +/- 8% (5 to 28%). Anticoagulant treatment comprised heparin, coumadin and aspirin in two cases, and, in the following 7 cases, low molecular weight heparin, ticlopidine and aspirin. There was one death due to cardiogenic shock on the third day despite intraaortic balloon pumping. One patient was operated for a femoral aneurysm. A prophylactic bypass procedure was performed as a semi-emergency in a stable patient. At systematic angiographic control, the residual stenosis was measured at 19 +/- 14% (10 to 43%) without reocclusion. There was no recurrence of ischaemia. The authors conclude that the encouraging results of this short series suggest that despite the highly thrombogenic situation of acute myocardial infarction and despite the context of emergency implantation of a stent. Palmaz-Schatz stent implantation gives good immediate and long-term results with respect to reocclusion and stenosis.
1991年12月至1994年11月期间，9例年龄为57±14岁的患者在心肌梗死急性期植入了Palmaz-Schatz支架。其中7例为直接血管成形术后，2例为在心肌梗死发病175±62分钟后进行的挽救性血管成形术，植入原因是存在夹层形成风险（8例）或血管成形术效果欠佳（1例）。支架植入成功率为100%，残余狭窄（采用飞利浦DCI系统测量）为16±8%（5%至28%）。抗凝治疗方面，2例患者使用肝素、香豆素和阿司匹林，随后的7例患者使用低分子肝素、噻氯匹定和阿司匹林。尽管进行了主动脉内球囊反搏，但仍有1例患者在第三天因心源性休克死亡。1例患者因股动脉瘤接受手术。对1例病情稳定的患者进行了半急诊预防性搭桥手术。在系统性血管造影复查时，残余狭窄为19±14%（10%至43%），无再闭塞情况。未出现缺血复发。作者得出结论，这一短系列的令人鼓舞的结果表明，尽管急性心肌梗死存在高血栓形成风险，且支架植入处于急诊情况下，但Palmaz-Schatz支架植入在预防再闭塞和狭窄方面可取得良好的近期和长期效果。
