Yamasaki M, Hara K, Masaki K, Kobayashi N, Nakajima H, Kouzuma K, Saeki F, Tamura T
Division of Cardiology, Mitsui Memorial Hospital, Tokyo.
J Cardiol. 1998 May;31(5):263-71.
Conventional balloon angioplasty treatment of aorto-ostial stenoses in native coronary arteries and saphenous vein grafts is associated with a low primary success rate, a high complication rate and a high incidence of restenosis. The short-term outcome of Palmaz-Schatz stent implantation in aorto-ostial lesions was compared with that of balloon angioplasty. Thirteen patients underwent stent implantation for 13 de novo lesions (four in the left main coronary trunk, two in the right coronary artery, seven in the vein graft) between January 1994 and December 1995. Fourteen patients underwent balloon angioplasty for 14 de novo lesions (five in the left main coronary trunk, four in the right coronary artery, five in the vein graft between January 1986 and April 1992. Both groups had similar clinical characteristics. Initial success was obtained in all patients in the stent group, compared with 71% of the balloon angioplasty group. Insufficient dilation was the main cause for such failure in the balloon angioplasty group. Baseline reference diameters were similar (3.40 +/- 0.65 mm in the stent group vs 3.36 +/- 0.42 mm in the balloon angioplasty group) and there was no difference in baseline minimal luminal diameter (1.41 +/- 0.74 vs 1.08 +/- 0.56 mm). Minimal luminal diameter was significantly greater in the stent group than in the balloon angioplasty group at both post-procedure and follow-up examinations (post: 3.36 +/- 0.58 vs 2.69 +/- 0.45 mm, p < 0.01; follow-up: 2.33 +/- 0.96 vs 1.52 +/- 0.68 mm, p < 0.05). There was no subacute occlusion in either group. The overall angiographic restenosis rate (> 50% stenosis) was lower in the stent group (17%) than in the balloon angioplasty group: the restenosis rates of native lesions were 0% in the stent group and 40% in the balloon angioplasty group; those of saphenous vein graft lesions were 33% in the stent group and 50% in the balloon angioplasty group. Although the number of patients was limited, these results suggest that Palmaz-Schatz stent implantation may be a safe and effective strategy for treating aorto-ostial lesions in both native coronary arteries and saphenous vein grafts.
对原发性冠状动脉和大隐静脉移植物的主动脉开口处狭窄进行传统球囊血管成形术治疗，其主要成功率低、并发症发生率高且再狭窄发生率高。比较了Palmaz-Schatz支架植入术治疗主动脉开口处病变与球囊血管成形术的短期疗效。1994年1月至1995年12月期间，13例患者因13处新发病变接受了支架植入术（左冠状动脉主干4处、右冠状动脉2处、静脉移植物7处）。1986年1月至1992年4月期间，14例患者因14处新发病变接受了球囊血管成形术（左冠状动脉主干5处、右冠状动脉4处、静脉移植物5处）。两组患者的临床特征相似。支架植入组所有患者均获得了初始成功，而球囊血管成形术组的成功率为71%。球囊血管成形术组此类失败的主要原因是扩张不足。两组的基线参考直径相似（支架植入组为3.40±0.65mm，球囊血管成形术组为3.36±0.42mm），基线最小管腔直径也无差异（分别为1.41±0.74mm和1.08±0.56mm）。在术后及随访检查中，支架植入组的最小管腔直径均显著大于球囊血管成形术组（术后：3.36±0.58mm对2.69±0.45mm，p<0.01；随访：2.33±0.96mm对1.52±0.68mm，p<0.05）。两组均未发生亚急性闭塞。支架植入组的总体血管造影再狭窄率（狭窄>50%）低于球囊血管成形术组（17%）：原发性病变的再狭窄率在支架植入组为0%，在球囊血管成形术组为40%；大隐静脉移植物病变的再狭窄率在支架植入组为33%，在球囊血管成形术组为50%。尽管患者数量有限，但这些结果表明，Palmaz-Schatz支架植入术可能是治疗原发性冠状动脉和大隐静脉移植物主动脉开口处病变的一种安全有效的策略。
