未预扩张病变直接冠状动脉内支架术

Direct Coronary Stenting in Patients without Balloon Predilation

目的:冠状动脉内支架植入前一般都要对靶血管进行预扩张,本研究目的在于观察不用球囊预扩张,直接在靶血管内置入冠状动脉内支架的可行性及疗效.方法:自1999年5月至2000年12月共有76例患者未用球囊预扩张靶血管,直接置入了78枚冠状动脉内支架.其中男性62例,女性14例:年龄54岁±11岁;稳定性心绞痛31例、不稳定性心绞痛18例、陈旧性心肌梗塞26例、急性心肌梗塞1例;病变位于左前降支42例,回旋支10例,右冠状动脉26例;A型病变32例,B型病变46例;病变均位于血管中、近端,无明显钙化,成角,迂曲;靶血管狭窄程度76.3%±4.9%,参照血管直径3.0mm±03mm.支架类型GFX36枚,MR28枚,Cross-Flex8枚,Rstent 6枚,平均长度123mm±3.1mm(9mm～18mm).结果:未对靶血管先进行扩张共置入78枚支架,其中77例支架顺利到位扩张成功.1例支架无法跨过病变,将支架取出用球囊预扩张后再次置入原支架顺利到位,置入成功,成功率为98.7%,术后狭窄程度减少至132%±5.4%,无严重内膜撕裂、急性闭塞、血栓等并发症发生.术后有10例病人进行了造影随访,其中6例发生了再狭窄.结论:在适当的病人中进行直接冠状动脉内支架术有较高的成功率和良好的远期效果.病变的特点应是:无或仅有轻度钙化、近端无中度以上弯曲,A及B型病变,限局性病变、狭窄程度＜90%.直接支架置入术可缩短手术及X线曝光时间,降低手术费用,减少急性闭塞的发生,是否能降低再狭窄率还有待于进一步研究.

ve: The target lesions would usually be predilated before the implantation of coronary stent. The aim of our study was to determine the feasibility and the clinical outcomes of direct coronary stenting without balloon predilation. Methods: From May 1999 to Dec 2000, 78 direct coronary stent implantation without predilation of target vessels in 76 patients, male 62, female 14, mean age was 54 ± 11 years. There were cases of stable angina 31, unstable angina 18, old myocardial infarction(OMI) 26 and acute which, there were type A lesions 32 and type B lesions 46, and these lesions were located in proximal & mid vessels without extreme calcification, angulation or turtuosity. The avarage narrowness of target vessels was 76.3±4.9%, and the reference vessel diameter was 3.0±0.3mm. The stents were GFX 36, NIR 28, Crosss-Flex 8 and Rstent 6; the average stent length was 12.3±3.1mm (9-18mm). Results: There were 76 cases .of implanted stents without predilatation of target vessels, in which, 75 stents were successfully deployed on the target lesions. There was 1 stent which failed to pass through the lesion, the stent was taken out then, finally, it was successfully deployed on the target lesion after predilation. The clinical success rate was 98.7%. Residual stenosis was decreased to 1.32 ± 5.4% after direct stenting. There were no complications like severe dissection, abrupt closure and thrombosis. Angiography follow-up was performed in 10 cases after direct stenting, in which, there were 6 cases with restenosis. Conclusion: There was a high procedural success and good in-hospita and long-term clinical outcomes in elective patients with direct coronary stenting. The lesion feature of direct stenting should be: without or just with slight calcification, without more than moderate turtuosity in the proximal part of lesion, type A or type B lesion, limitedlesion and narrownessless than 90%. Direct stenting was associated with shorter procedure time, reduced fluoroscopy time, lower equipment costs and contrast use, and decreased abrupt closure, compared with conventional stenting with predilatation. Whether this new approach Could reduce the restenosis rate warrant further studies.