雷帕霉素洗脱支架治疗冠状动脉长病变的随访观察

Clinical and angiographic follow-up observation of sirolimus-eluting stents in the treatment of complex coronary lesions

目的评价雷帕霉素洗脱支架(CYPHERTM支架)治疗冠状动脉(冠脉)长病变的安全性及疗效。方法43例冠脉长病变且有临床缺血症状的患者接受了CYPHERTM支架治疗,51处靶病变共置入62个CYPHERTM支架。观察手术成功率、并发症、随访期间心脏不良事件发生率、再狭窄率及晚期管腔丢失等。结果所有支架均成功置入,无残余狭窄或残余狭窄<10%,未见任何并发症。临床随访(11±3.5)个月(6～19个月),临床随访率100%,有2例症状再发(支架内再狭窄)而再次血运重建,其余患者均未发生任何心脏不良事件,无一例死亡。36例患者术后(9±2.2)个月(6～14个月)复查了冠脉造影,造影随访率84%,支架近端边缘节段平均晚期管腔丢失(0.26±0.05)mm,支架内平均晚期管腔丢失(0.21±0.03)mm,支架远端边缘节段平均晚期管腔丢失(0.10±0.02)mm,病变再狭窄率4.8%(2/42),病例再狭窄发生率5.6%(2/36),再次血运重建率4.7%(2/43)。结论CYPHERTM支架治疗冠脉长病变安全、有效,能明显降低6个月后的支架内再狭窄率及再次血运重建率。

Objective To investigate the safety and effectiveness of sirolimus-eluting stents(SESs) in the treatment of coronary long lesions.Methods 62 SESs were implanted in 43 patients with 51 long lesions and objective evidence of ischemia.We observed the procedural success and complication rates during hospital.Major adverse cardiac events,restenosis rate and late lumen loss were also observed at follow-up.Results All stents were implanted successfully.There was no remained stenosis and major in-hospital complications.During a clinical follow-up period of 11 months,2 patients had recurrent angina because of angiographic evidence of in-lesion restenosis which needed for target vessel revascularization.No major adverse cardiac events was found in other 41 patients,and no one died.Quantitative coronary angiographies of 36 patients were obtained after the procedure and at about 9 months.The late lumen loss of proximal edge vessel averaged (0.26±0.05)mm,of in-stent (0.21±0.03)mm,and of distal edge vessel (0.10±0.02)mm.Angiographic in-lesion restenosis rate was 4.8%,case recurrence rate 5.6% and target vessel revascularization 4.7%.Conclusion SES is safe and effective in treating patients with coronary long lesions,and it can strikingly decrease the rates of restenosis and target vessel revascularization after 6 months of follow-up.