球囊预扩张充盈压对冠脉支架植入术临床疗效的影响

Influence of balloon predilation pressure before stent implantation in de novo coronary artery lesion on clinical outcome

目的 :评估球囊低压力预扩张对冠脉内支架术后临床疗效的影响。方法 :依据不同球囊预扩张压力将入选的91例冠心病患者分为低压力组 (最大扩张压力≤ 12 atm )、高压力组 (>12 atm ) ,观察住院期间严重临床事件率和术后 6～ 18个月无心脏事件存活率。结果 :低压力组球囊最大预扩张压力为 8.3± 1.6 atm ,高压力组为 13.9± 0 .3atm (P<0 .0 5 ) ,144个支架均成功置入。低压力组和高压力组在术中的血管夹层及撕裂的发生率分别为 8.2 %和19.0 % (P<0 .0 5 ) ,住院期间低压力组发生死亡为 0例 ,高压力组为 1例 ;6 8例患者接受了术后 6～ 18个月的临床随访 ,无心脏事件存活率低压力组为 74% ,高压力组为 6 1% ,其中 13例在随机冠状动脉造影随访中发现支架内再狭窄 ,低压力组为 6例 ,高压力组为 7例。结论 :低压力球囊预扩张可减少支架术中的急性血管并发症 ,不影响支架置入的远期疗效。

AIM:To assess the role of low pressure pre dilation in the clinical outcome of patients undergoing percutaneous transluminal coronary angioplasty(PTCA) and stenting. METHODS: Ninety one patients with coronary heart disease treated with PTCA and stenting were assigned into low (≤12 atm,49 patients) or high (>12 atm,42 patients) balloon pressure pre dilation . The event free survival at 6~18 months follow up and the incidence of adverse clinical events during the hospitalization were investigated. RESULTS: The maximal balloon pre dilation pressure was 8.3±1.6 atm in low pressure group, and 13.9±0.3 atm in high pressure group( P <0.05). During the hospitalization, there was no Q wave myocardial infarction in low pressure group, but one in high pressure group who underwent repeat PTCA. The incidence of adverse vessel events during the operation was 8.2% for low presure pre dilation and 19.0% for high pressure group( P <0.05). Event free survival at 6~18 months follow up was not significantly different between the two groups. CONCLUSION: The use of low pressure balloon pre inflation before coronary stent placement reduces the incidence of acute vascular complication while is not associate with any significant influence on the 6~18 months outcome of patients undergoing this intervention.