在小冠状动脉中置入支架的安全性与有效性研究

Safty and Efficacy of Stent Implantation in Small Coronary Arteries

目的：随着经皮冠状动脉腔内成形术（ＰＴＣＡ）操作者经验的积累，支架置入技术的提高和术前、术后药物治疗方案的改进，已使大的冠状动脉（直径≥３．０ ｍ ｍ ）置入支架后支架内血栓形成和闭塞的危险性明显降低，但是在小血管中（直径＜ ３．０ ｍ ｍ ）置入支架是否也有同样好的结果尚不十分清楚，本文旨在检验在小血管中置入支架的安全性与有效性。 方法：我们在７９ 例病人的８３ 支小冠状动脉中置入了８４ 个支架，采用的支架置入技术为支架置入后用稍大一点或相同大小的非顺应性球囊高压扩张，术前、术后予以阿司匹林和噻氯匹定（抵克力得）联合治疗。 结果：成功的支架置入使病变直径狭窄从（７９．０７±１５．５９）％ 降至（－ ０．３８±７．１７）％ ，无支架内血栓形成，使并发症发生率降低，６６ 例病人在６ 个月的临床随访中，大部分病人（８９．０％ ）仍保持无症状；在冠状动脉造影随访中，支架内再狭窄率为２９．６％ 。 结论：在直径＜ ３．０ ｍ ｍ 的小冠状动脉中置入支架手术成功率高，有明显的即刻血管腔扩大，支架内血栓形成和术后出血并发症发生率低，并有可接受的再狭窄率。

Objective:Stent implantation in large coronary arteries (≥3 0 mm in diameter) has shown excellent acute results and lower risk of thrombotic stent closure and significantly reduced restenosis rates.However,whether same favorable outcomes might be obtained by stent placement in small vessels (<3 0 mm in diameter) has not been clearly determined. Methods:We implanted 84 balloon expandable stent in 83 small coronary arteries in 79 consecutive patients using a little bite larger balloons or same sized balloons with highpressure dilatation techniques.We also used the combination therapy of asprin and ticlopidine before and after stent implantation. Results:Successful stent implantation reduced the lesion diameter stenosis from (79 07±15 59)% to (-0 38±7 17)%,no stent thrombosis occurred.At 6 months follow up,event free survival was achieved in 89 00%,restenosis occurred in 29 6% of patients. Conclusion:Stent implantation in small coronary arteries <3 0 mm in diameter is safe and effective.It is associated with significant lumen enlargement and a low risk of stent thrombosis and an acceptable in stent restenosis rate.