药物涂层支架在复杂冠脉病变中的临床应用

Drugs-Eluting Stent for Treatment of Complicated Coronary Disease

目的观察药物涂层支架治疗复杂冠状动脉病变的临床效果。方法对2004年10月至2006年3月收治的152例冠心病患者置入药物涂层支架，治疗病变184处，包括左主干病变4处，前降支病变113处，右冠病变39处，回旋支病变28处。c型病变48例，B2型病变94例。病变长度（25±7．3）mm，术前病变狭窄程度85．9％±11．4％；血管直径（3．03±0．72）mm。观察药物涂层支架的手术成功率、术中并发症、住院期间及临床随访期间的心脏事件。结果152例患者治疗184处病变，共置入药物涂层支架207个，手术即刻成功率100％，术后造影病变残余狭窄〈10％，支架完全覆盖病变，支架近远端无新夹层，血流TIMI3级。临床随访8±2．4（3～14）个月，144例患者心绞痛消失，运动耐量增加，3例术后6个月出现心绞痛，临床症状复发率2．06％。随访期1例死亡，无一例心肌梗死和急诊搭桥，结论药物涂层支架降低复杂病变再狭窄率，手术成功率高，为复杂病变介入治疗提供可能，但远期效果有待进一步观察。

Objective Clinical effect of Drugs-eluting stent for treatment of complicated coronary disease has been observed. Methods From October 2004 to March 2006,152 patients bad been placed drugs-elu- ring stent. 152 and eighty-five lesions had been treated,including 4 of left main lesion,one hundred and thirteen of left anterior descending artery, 39 of right coronary arteries, 28 of left circumflex arteries. According to the American College of Cardiology-American Heart Association classification, there were 48 patients of C type lesions,94 patients of B2 type lesions. Lesion length was（25±7.3）mm. Preprocedure degree of stenosis is 85.9%± 11.4% ; Luminal diameter was （3.03±0.72） mm. Successful rate, complications and cardiac events bad been observed during in-hospital and follow-up. Results 207 drugs-eluting stents bad been placed in 184 lesions of 152 patients. Immedirectly successful rate was 100 percent. Residual stenosis in post-procedure was less than ten percent. Lesions were covered by stent completely. There was no new dissection in the proximal and distal vessel of stent,and flow was TIMI 3 grade. During three to fourteen months of follow-up （ mean 8±2.4 months） ,and angina pectoris disappeared in 144 cases. There were increasing exercise tolerance in all patients. Angina pectoris reappeared in three cases after six months. Clinic symptom recrudescence rate is 2.06 percent. One case happened death during follow-up. No patient happened myocardial infarction,and emergency CABG. Conclusion Drugs-eluting stent can reduce restenosis rate of complicated coronary disease. Successful rate of procedure was high. Drugs-eluting stents for treatment of complicated coronary disease may be likelihood. Long term effect must be observed still further.