Ramondo A, Bertaglia E, Fiocca L, Isabella G, Cardaioli P, Razzolini R, Chioin R
Servizio di Emodinamica e Cardiologia Interventistica, Università degli Studi, Padova.
Cardiologia. 1997 Dec;42(12):1271-6.
Patients with recurrent angina after coronary artery bypass graft surgery pose a problem. Stent implantation has been advocated in an effort to avoid repeat operation and to address the limitations of balloon angioplasty. Aim of the present study was to determine the in-hospital and long-term results of stent deployment in focal, de novo lesions of vein grafts. Thirty-five focal, de novo lesions of vein grafts in 31 patients were treated with stent deployment. Twenty-four patients (77%) had three vessels, 6 (20%) two vessels and 1 (3%) single vessel disease. Saphenous vein grafts aged 9.7 +/- 4.2 years (range 1-19 years). Twenty-two lesions (63%) were located within the body of the saphenous graft, 8 (23%) at the graft/coronary artery anastomosis and 5 (14%) at the aorta/graft anastomosis. The indications for stent deployment included: suboptimal result from balloon angioplasty (defined as > or = 50% post-angioplasty residual stenosis) in 29/35 lesions (83%); post-angioplasty coronary dissection with threatening occlusion in 4/35 (11%); abrupt closure in 2/35 (6%). Patients were screened for death, myocardial infarction, bypass surgery and repeat angioplasty during in-hospital stay and after a follow-up of 12 +/- 8 months. Even-free survival curve was constructed by the Kaplan-Meier method. Stent deployment was successful in all patients. One stent was deployed in 24/35 lesions (69%), half Palmaz-Schatz stent in 6/35 (17%) and 2 or more stents in 5/35 (14%). The balloon/vessel ratio resulted of 1.0 +/- 0.1 Minimal lumen diameter increased from 0.8 +/- 0.4 to 3.8 +/- 0.6 mm, with a mean gain of 1.8 +/- 0.6 mm (range 1.8-4.0 mm). During the in-hospital period 1 patient (3.2%) died and 1 (3.2%) had a non Q wave myocardial infarction. Therefore, the clinical success rate, was 94%. During the follow-up period, 2 patients died (6.9%), 2 (6.9%) developed a non Q wave myocardial infarction, 1 (3.4%) underwent bypass surgery and 3 (10.3%) underwent repeat angioplasty. The estimated 2-year event-free survival rate (free from myocardial infarction, repeat surgery and repeat angioplasty) was 62%. In conclusion, Palmaz-Schatz stent deployment in focal, de novo vein grafts presents a high rate of procedural success, a low rate of acute complications and good long-term results.
冠状动脉搭桥手术后出现复发性心绞痛的患者是个难题。有人主张进行支架植入，以避免再次手术并解决球囊血管成形术的局限性。本研究的目的是确定在静脉移植物局灶性、初发性病变中植入支架的住院期间及长期结果。对31例患者的35处静脉移植物局灶性、初发性病变进行了支架植入治疗。24例患者（77%）有三支血管病变，6例（20%）有两支血管病变，1例（3%）有单支血管病变。大隐静脉移植物的年龄为9.7±4.2岁（范围1 - 19岁）。22处病变（63%）位于大隐静脉移植物主体内，8处（23%）位于移植物/冠状动脉吻合处，5处（14%）位于主动脉/移植物吻合处。支架植入的指征包括：29/35处病变（83%）球囊血管成形术效果欠佳（定义为血管成形术后残余狭窄≥50%）；4/35处病变（11%）血管成形术后冠状动脉夹层并有威胁性闭塞；2/35处病变（6%）急性闭塞。在住院期间以及12±8个月的随访期内，对患者进行死亡、心肌梗死、搭桥手术及再次血管成形术的筛查。采用Kaplan - Meier法构建无事件生存曲线。所有患者支架植入均成功。24/35处病变（69%）植入1枚支架，6/35处病变（17%）植入半枚Palmaz - Schatz支架，5/35处病变（14%）植入2枚或更多支架。球囊/血管直径比为1.0±0.1。最小管腔直径从0.8±0.4毫米增加到3.8±0.6毫米，平均增加1.8±0.6毫米（范围1.8 - 4.0毫米）。住院期间，1例患者（3.2%）死亡，1例（3.2%）发生非Q波心肌梗死。因此，临床成功率为94%。随访期间，2例患者死亡（6.9%），2例（6.9%）发生非Q波心肌梗死，1例（3.4%）接受搭桥手术，3例（10.3%）接受再次血管成形术。估计2年无事件生存率（无心肌梗死、再次手术及再次血管成形术）为62%。总之，在静脉移植物局灶性、初发性病变中植入Palmaz - Schatz支架具有较高的手术成功率、较低的急性并发症发生率及良好的长期效果。
