De Scheerder I K, Wang K, Kostopoulos K, Dens J, Desmet W, Piessens J H
Department of Cardiology, University Hospital Gasthuisberg, Leuven, Belgium.
Am Heart J. 1998 Aug;136(2):345-51. doi: 10.1053/hj.1998.v136.89578.
Recently, long (> or =20 mm) coronary stents were introduced for clinical use. They are intended as an alternative to multiple conventional stents to treat extensive dissections or suboptimal results of long lesions after balloon angioplasty.
In a total of 113 such consecutive vessels in 107 patients, the flexible Freedom stent was implanted. In 60 of these vessels, because of anatomic constraints, multiple overlapping short (16 mm) stents were implanted. The other 53 vessels were treated with a single long (> or =20 mm) stent.
In the single stent group there were four implantation failures (8%) successfully managed by crossover to multiple overlapping short stents. During early follow-up, in-stent thrombosis was not observed, but three patients with a single long stent and two patients with multiple overlapping stents suffered myocardial infarction as a result of long lasting myocardial ischemia during a difficult angioplasty procedure. At 6-month follow-up, > or =50% restenosis was measured in 29% and 35% of the patients with a single long stent and in those with multiple overlapping stents, respectively (not significant).
Compared with the alternative treatment modality (i.e., implantation of multiple short stents), no difference between in-hospital and 6-month outcome was observed. However, implantation of a single long stent, when technically feasible, reduces catheterization time, dye volume for the patient, and radiation exposure for both patient and operator during these embarrassing angioplasty procedures.
最近，长（≥20毫米）冠状动脉支架已引入临床应用。它们旨在作为多个传统支架的替代物，用于治疗广泛的夹层或球囊血管成形术后长病变的不理想结果。
在107例患者的总共113条此类连续血管中植入了柔韧性好的Freedom支架。在其中60条血管中，由于解剖学限制，植入了多个重叠的短（16毫米）支架。另外53条血管用单个长（≥20毫米）支架进行治疗。
在单支架组中，有4例植入失败（8%），通过改用多个重叠短支架成功处理。在早期随访期间，未观察到支架内血栓形成，但在一次困难的血管成形术过程中，3例使用单个长支架的患者和2例使用多个重叠支架的患者因长期心肌缺血发生心肌梗死。在6个月随访时，使用单个长支架的患者和使用多个重叠支架的患者中分别有29%和35%测量到≥50%的再狭窄（无显著性差异）。
与替代治疗方式（即植入多个短支架）相比，未观察到住院期间和6个月结果之间的差异。然而，在技术可行时，植入单个长支架可减少这些棘手的血管成形术过程中的导管插入时间、患者的染料用量以及患者和操作者的辐射暴露。
