Gambhir D S, Singh S, Trehan V, Arora R
Department of Cardiology, GB Pant Hospital, New Delhi.
Indian Heart J. 1998 Mar-Apr;50(2):183-6.
Elective stenting as a primary strategy for non-surgical revascularisation was performed in five patients with symptomatic unprotected left main coronary artery ostial stenoses. Their ages ranged from 24 to 57 years (mean: 44.6 +/- 14.4 years). Left ventricular ejection fraction ranged from 35 to 55 percent. All patients underwent successful stenting for left main ostial stenoses using a disarticulated 7 mm Palmaz-Schatz stent. Luminal diameter stenosis reduced from 74 +/- 10.8 to 10 +/- 7.2 percent after the procedure. One patient developed recurrence of angina on the 7th day due to marked recoil of the left main coronary artery with possible thrombosis, requiring immediate coronary artery bypass graft surgery without any sequelae. Remaining four patients were asymptomatic over a mean follow-up of 54 +/- 36 weeks (range: 25-96) and none developed angiographic restenosis at six months. Our preliminary observations therefore suggest that primary stenting is a feasible alternative to bypass graft surgery in patients with unprotected left main coronary artery ostial stenoses.
对5例有症状的非手术血运重建患者，采用选择性支架置入作为主要策略，对其无保护的左冠状动脉主干开口狭窄进行治疗。患者年龄24至57岁（平均：44.6±14.4岁）。左心室射血分数为35%至55%。所有患者均使用7mm的Palmaz-Schatz支架成功对左主干开口狭窄进行了支架置入。术后管腔直径狭窄率从74±10.8%降至10±7.2%。1例患者在第7天因左冠状动脉主干明显回缩并可能有血栓形成而出现心绞痛复发，需立即进行冠状动脉旁路移植术，术后无任何后遗症。其余4例患者平均随访54±36周（范围：25 - 96周）无症状，6个月时均未出现血管造影显示的再狭窄。因此，我们的初步观察表明，对于无保护的左冠状动脉主干开口狭窄患者，初次支架置入是冠状动脉旁路移植术的一种可行替代方法。
