PTCA后冠状动脉再狭窄的血管内支架治疗

Coronary artery restenosis after PTCA treated with intravascular stent

目的：采用血管内支架经皮腔内冠状动脉成形术（ＰＴＣＡ）后冠状动脉再狭窄，利用运动试验来追踪评价其１年疗效。材料与方法：观察３２例ＰＴＣＡ成功病例，其中６例在术后１～８个月被诊断为再狭窄，选择Ｇｉａｎｔｕｒｃｏ－Ｒｏｕｂｉｎ型支架做再成形治疗，在术后第１、６、１２个月测定其运动试验结果，将所测定指标与单纯ＰＴＣＡ组病例做同期对照。结果：６例血管造影均为原部位的单支血管再狭窄，经支架成形处理后，狭窄度由９０．５％±３．４％（ｘ±ｓ）下降为１０．２％±６．７％；术后１年追踪运动试验表明，支架成形组较单纯ＰＴＣＡ组在运动耐量和运动时间方面占优势。结论：再狭窄的发生除了与血管内膜增生反应相关外，还与血管壁的慢性回缩和结构重塑相联系；血管内支架可对抗这一过程的发生，从而提高中远期疗效。

Purpose: Coronary artery restenosis after PTCA was treated with intravascular stent, and the 1 year curative effect as evaluated by exercise test. Materials and methods: Successful PTCA of 32 cases were enrolled and 6 of them were diagnosed as restenosis 1—8 months after PTCA. Reangioplasty with Gianturco Roubin stent and follow up study with exercise test were carried out at 1, 6, 12 months. The results were compared with the group using PTCA. Results: Restenosis of the 6 cases all occurred at the same location of a single vessel. The degree of stenosis decreased from 90.5%±3.4% ( ±s ) to 10.2%±6.7% after stent angioplasty. The therapeutic results at 1 year follow up indicated that stent reangioplasty was superior to PTCA in terms of exercise capacity and exercise time. Conclusion: The mechanism of restenosis is related not only to vascular reactive endothelial hyperplasia, but also to chronic vascular recoil and reconstruction. The stent could play a role in counteracting the process of restenosis there by improving the mid and long term therapeutic effect.