慢性冠状动脉闭塞置入支架术与球囊扩张术的比较

Long term clinical and angiographic outcome after stenting and angioplasty of chronic total coronary occlusion

目的为了解冠状动脉内支架及经皮冠状动脉腔内成形术（ＰＴＣＡ）治疗完全闭塞性冠状动脉血管的临床及冠状动脉造影效果。方法９５例完全冠状动脉闭塞的病人随机分成为：置入支架组（Ａ组４８例）；单纯ＰＴＣＡ组（Ｂ组４７例），观察二组病人发生临床事件及６个月后的冠状动脉造影效果。结果６个月后两组病人完成临床及冠状动脉造影随访的共８５例，随访率为８９％，Ａ组４２例，Ｂ组４３例。Ａ组：１例于术后１０天内出现心肌梗塞，无１例死亡，其再狭窄率为２８．５％，血管再闭塞率为１１９％，最终重复血管重建术为１９％。Ｂ组：１例死亡，２例发生急性心肌梗塞，再狭窄率为５８％，血管再闭塞率为２２％，最终重复血管重建术达４５％。两组之间临床疗效差异均有显著性（Ｐ＜０．００１）。结论冠状动脉慢性闭塞的病人ＰＴＣＡ成功后选择性置入支架比单纯ＰＴＣＡ的近期及远期临床疗效预后要好（发生临床事件及重复血管重建术明显下降）。

Objective This study was to investigate the long term clinical and angiographic outcome after stenting or balloon angioplasty treatment of chronic total coronary artery occlusion. Methods Ninty five patients with successful PTCA for total occluded coronary artery were collected from 358 patients with PTCA for chronic total occlusion lesions, patients were classified into two groups, group A with selective stenting after successful PTCA ( n= 48), group B with PTCA (n=47) only the clinical cardiac events and angiography were evaluated after six months of the procedure.Results 85 (89%) in 95 patients were followed up, in the stent group (n=42), one patient suffered from AMI, in group B, 2 patients with AMI and one died in hospital. Restenosis rate in stent group was 28.5% compared with 58% in group B ( P <0.001), the reocclusion was 11.9% in group A and 19% in group B. Recanulazation was 19% in group A and 45% in group B ( P <0.01). Conclusions Selective stenting for total occluded coronary artery after successful PTCA improved the short and long term clinical and angiographic results.