Bolte J, Diefenbach C, von Olshausen K
III. Medizinische Abteilung, Schwerpunkt Kardiologie/Pneumologie, Allgemeines Krankenhaus Altona, Hamburg.
Z Kardiol. 1998 Sep;87(9):707-14. doi: 10.1007/s003920050230.
Extensive coronary dissections are rare but represent serious complications of percutaneous transluminal coronary angioplasty (PTCA). In order to prevent dissections in large coronary vessels (> or = 2.5 mm), we evaluated stent implantation without predilatation in 98 selected patients with favorable coronary anatomy and lesion morphology.
Coronary stenting without predilatation was performed 41 times in the LAD, 41 times in the RCA, 11 times in the RCx, and 5 times in a vein graft. Mean diameter stenosis was 83 +/- 3%. Thirty-six patients had type A lesions and 62 patients type B lesions. Patients with type C lesions were excluded. Only premounted stents were used.
The clinical situation was stable angina in 68 patients, unstable angina in 18, and acute myocardial infarction in 12. Stenting without predilatation was successful in 92 patients (94%). In 6 cases (6%) it was not possible to cross the lesion with the premounted stent, and predilatation was necessary prior to successful stent implantation. Two out of 11 RCx-related lesions (18%) could not be stented without predilatation. However, ultimate success of PTCA was 100%. No stent was lost. Mean remaining stenosis amounted to 3 +/- 6%. Minor angiographically detectable dissections after stent deployment were noted in 8 patients (8%). Inflation time (30 +/- 22 s) and fluoroscopic time (4.5 +/- 2.1 min) compared favorably to standard procedures. During 30 d follow-up no subacute stent thrombosis, but 2 non-Q-wave myocardial infarctions due to lost side branches were reported.
Coronary stenting with premounted stents without predilation is feasible and safe in selected patients in order to reduce fluoroscopic and procedural time and to save costs. Furthermore, this procedure might reduce the risk of hazardous coronary dissections.
广泛冠状动脉夹层很少见，但却是经皮腔内冠状动脉成形术（PTCA）的严重并发症。为预防大冠状动脉（直径≥2.5mm）发生夹层，我们对98例冠状动脉解剖结构和病变形态良好的入选患者进行了无预扩张支架植入术评估。
左前降支（LAD）无预扩张冠状动脉支架植入术进行了41次，右冠状动脉（RCA）41次，回旋支（RCx）11次，静脉桥血管5次。平均直径狭窄率为83±3%。36例患者为A型病变，62例为B型病变。C型病变患者被排除。仅使用预装支架。
68例患者临床表现为稳定型心绞痛，18例为不稳定型心绞痛，12例为急性心肌梗死。92例患者（94%）无预扩张支架植入术成功。6例（6%）患者无法用预装支架穿过病变，在成功植入支架前需要进行预扩张。11例与回旋支相关的病变中有2例（18%）无预扩张无法植入支架。然而，PTCA的最终成功率为100%。无支架脱落。平均残余狭窄率为3±6%。8例患者（8%）在支架置入后血管造影显示有轻微可检测到的夹层。与标准操作相比，充盈时间（30±22秒）和透视时间（4.5±2.1分钟）更短。在30天随访期间，未报告亚急性支架血栓形成，但有2例因侧支血管丢失导致的非Q波心肌梗死。
对于选定患者，使用预装支架进行无预扩张冠状动脉支架植入术是可行且安全的，可减少透视和手术时间并节省费用。此外，该操作可能会降低危险冠状动脉夹层的风险。
