9种类型冠状动脉支架的临床应用体会

Clinical Application and Initial Experience with Nine Types of Intracoronary Stents

对 4 0例冠心病患者的 4 1支冠状动脉 4 2处病变植入 51枚冠脉内支架。植入的支架类型包括 :Bestent支架 ,BardXT支架 ,Angio支架 ,AVE支架 ,Devon支架 ,Multi-link支架 ,Wiktor支架 ,CVD支架及Gianturco -RoubinⅡ支架等 9种。支架选择按靶病变长度、近端血管内径大小及病变特点进行。支架释放压力为 6～ 14个atm ,时间为 30～ 6 0秒 ,之后经 2个以上的相互垂直平面造影证实支架充分扩展 ,远端血流达TIMIⅢ级为手术成功 ,手术成功率 96 .1%。其中 5例病人拔除动脉鞘管后压迫股动脉时出现窦缓伴血压下降 ,经静脉推注阿托品后好转 ,2例穿刺部位出现血肿。术后随访 1～ 2 9个月 ,有 4例再发心绞痛 ,其中 3例经造影证实植入支架血管血流正常 ,其它支发生再狭窄导致。我们认为冠状动脉支架术是安全而有效的冠心病介入性治疗方法 ,手术成功率高 ,并发症少。根据靶血管病变特征合理选用不同类型的支架是保证支架植入成功的重要环节。

A total of 51 stents were implanted in 40 patients,41 vessels and 42 lesions.9 types of stents were used,including Bestent stent,Bard XT stent,Angio stent,AVE stent,Devon stent,Multi-link stent, Wiktor stent,CVD stent and Gianturco-Roubin Ⅱ stent . Stents were selected according to lesion length,diameter of adjacent normal coronary segment and lesion characteristics.Stent was performed with inflation pressures ranging from 6 to 14 atm,which were held for 30 to 60 seconds.The criteria of success were adequate expansion of stents and TIMI grade 3 flow in the dismal vessel assessed by at least two orthogonal views.The procedure success rate was 96.1%.Sinus bradycardia and BP decrease occurred in five cases when we compressed femoral artery after removing the arterial shealth but recovered after intravenous atropin.Two cases had hematoma in the puncture site.During one to twenty-nine months follow-up,four cases had chest pain again,three of which underwent angiography and none developed restenosis within the stented segment.In conclusion,coronary stent is a safe and efficacious method with high success and low complication rate in interventional cardiology.Selecting different stents according to different characteristics of lesion has an important role in implanting stents successfully.