Endeavor支架治疗冠心病左主干病变的临床疗效观察

Clinical obsvervation of endeavor zotaroliums-eluting stent in patients with left main coronary artery stenosis

目的:评价Endeavor支架治疗选择性冠心病无保护左主干病变的安全性和有效性。方法:2006年9月至2008年1月,共84例经选择的冠心病无保护左主干病变患者,年龄37～78岁,平均(59.6±14)岁,其中男性60例(71%),有糖尿病者24(29%),左主干狭窄均≥75%,均接受Endeavor支架治疗,随访12个月,随访终点指标:不良心脏事件(MACE)率、靶血管重建(TVR)率,支架血栓发生率。结果:84例患者介入治疗均获得成功,共植入Endeavor支架148枚。其中左主干开口部狭窄8例(10.4%,8/84),体部狭窄12例(12.5%,12/84),远端分叉部位狭窄64例(76.2%,64/84)。64例远端分叉部位狭窄患者均使用分步Crush技术处理主支和边支。所有患者治疗后临床症状明显缓解或消失,12个月MACE率为7.1%,TVR率为7.1%,支架血栓发生率为0%。结论:Endeavor支架介入治疗冠心病无保护左主干病变安全有效,近期效果良好。

Objective：Surgical revascularization is the treatment of choice in patients with left main coronary artery stenosis. Conventional stents are not a valid alternative because of the rate of restenosis and sudden cardiac death. Drug-eluting stents,which reduce the rate of restenosis,may represent an alternative to cardiac surgery. A second-generation drug-eluting stent,which delivers zotarolimus,a potent antiproliferative agent,via a biocompatible phosphorylcholine polymer on a cobalt alloy thin-strut stent has shown promising experimental and early clinical results. however,the safety and eficacy of ZotaroliumsEluting stent in patients undergone percutaneous coronary intervention （PCI） for left main coronary artery stenosis is unknown. The objective of this study was to evaluate the safety and eficacy of Endeavor Zotaroliums-Eluting Stent in patients undergone percutaneous coronary intervention （PCI） for left main coronary artery stenosis who were poor candidates for surgical revascularization. Methods：From September 2006 to January 2008,a total of 84 patients with Left main coronary artery stenosis [mean age：（59. 6 ± 14） year（37-78） years,males 60（71% ）,diabetes 24 （29%）,stenosis diameter ≥75%]implanted with Endeavor Zotaroliums -Eluting Stents were enrolled in this study. Exclusion criteria were ST-segment elevation myocardial infarction （MI） within 48 h of symptom onset; prior bypass graft surgery; in-stent restenosis; cardiogenic shock; malignancies or other comorbid conditions with life expectancy 1 year or that might result in protocol noncompliance; left main size 4. 5mm. All patients were pre-medicated with aspirin 300 mg and clopidogrel 300 mg in the day before the procedure,and procedural heparin was given （70-100 U/kg） to keep activated clotting time 250 s. Post-stenting regimen included aspirin 100 mg,and clopidogrel 75mg daily for at least 12 months according to ACC/AHA CAD Guide-line. The use of glycoprotein IIb/IIIa inhibitor was left to the operator＇s discretion. The indication of PCI is based on ACC/AHA CAD Guideline. All PCI procedures were done with femoral approach. Different stenting techniques for LMCA bifurcation were decided according to the actual angiographic findings. Single stent ＂crossover＂was chosen when the ostium of1 of the LMCA branches was not narrowed. Other complex stenting techniques,including＂culottes＂,＂crush,＂＂T＂,and＂V＂,was chosen based on the actual configuration and extent of the stenosis in patients with significant narrowing （ 50% ） at both ostia of LMCA branches. Final kissing balloon technique （KBT） was required in all patients with LMCA bifurcation involvement. Procedural success was defined as the achievement of final diameter stenosis b20% with Thrombolysis in Myocardial Infarction （TIMI） 3 flow,without major peri-procedural complications （death,MI,or repeat revascularization during hospitalization）. A follow-up angiography was requested after 12 months,MACE rates ,TVR rate,stent-thrombosis rate were analyzed in-hospital and 12 months fllowed-up. Results：The procedure success rate was 100% , including ostia lesions（8 pats） ,body lessions （12 pats）,bifurcation lesions（64 pats）（received PCI with crush technique） ,MACE rates ,TVR rate ,and stent-thrombosis rate was 7. 1% ,7. 1% ,and 0% respectively after 12 months fllowed-up. Conclusion：Implanting of Endeavor Zotaroliums-Eluting Stent in patients undergone percutaneous coronary intervention （PCI） for left main coronary artery stenosis May be safe and effective,Endeavor Zotaroliums-Eluting Stent deserves to be considered a safe and effective alternative to CABG in institutions performing large numbers of PCI.