小血管支架点状置入与雷帕霉素洗脱支架治疗小血管长病变的对照研究  

Comparison of stenting with sirolimus eluting stent and spot stenting with small vessel stent in treatment of small vessels with long lesions

作　　者：李新明[1] 王圣[1] 李斌[1] 王天松[1] 陈关良[1] 王卫[1] 马建林[1] 王青[1] 苏哲坦[1] 

机构地区：[1]海南省人民医院心内科

出　　处：《中华医学杂志》2007年第4期265-267,共3页National Medical Journal of China

基　　金：海南省自然科学基金(30317)

摘　　要：目的评价小血管支架点状置入与雷帕霉素洗脱支架治疗小血管长病变的近期以及远期疗效。方法 2002年12月至2005年8月接受经皮穿刺冠状动脉介入治疗的小血管、长病变(血管直径<3.0 mm,病变长度>20 mm)患者。根据其治疗策略分为小血管支架点状置入组(SVS组)及雷帕霉素洗脱支架组(SES 组)。观察两组术后6个月时支架内再狭窄、靶病变再次血运重建(TLR)以及主要不良心脏事件(MACE)发生率。结果共有206例患者入选,其中 SVS 组113例,SES 组93例。两组之间基础临床及病变血管特征均无显著差异。SES 组有2例病变血管迂曲、钙化,CYPHER 支架不能通过,换用 DRIVER 支架后顺利完成手术。在随访期间 SES 组支架内再狭窄发生率(4.0%vs 26.5%,P<0.05),TLR 发生率(2.2%vs 10.6%,P<0.05)以及 MACE 发生率(3.2%vs13.3%,P<0.05)均明显低于 SVS 组。结论对于 SES 通过困难的小血管、长病变,可选用 SVS 点状置入。Objective To evaluate the short and long-term outcomes between stenting with sirolimus eluting stent （SES） and spot stenting with small vessel stent （SVS） for treatment of small vessels with long lesions. Methods 306 coronary heart disease patients in need of stenting in small vessel （ diameter 〈 3.0 mm） with long lesions （ 〉20 mm） were divided into 2 groups： SES group （n =93, receiving 157 CYPHER stents） and SVS group （ n = 113, receiving spot stenting tactics）. The clinical characteristics, success rate of procedure, rate of in-stent restenosis, target lesion revaseulation （TLR） , and major adverse cardiac events （MACE） were recorded after 6-month follow-up. Results The baseline clinical and angiographic characteristics were similar between these two groups. Two CYPHER stents failed to pass the tortuous and calcified lesions in the SES group; DRIVER stents were used instead and succeeded in the passing. The rates of in-stent restenosis, TLR, and MACE of the SES group were 4.0% , 2.2% , and 3.2% respectively, all significantly ,lower than those of the SVS group （26.5 %, 10.6%, and 13.3 % respectively, all P 〈 0. 05 ）. Conclusion In treatment of small vessel with long lesions, the rates of in-stent restenosis, TLR, and MACE are all much lower in the SES group than in the SVS group. Spot stenting with SVS may be feasible for small vessels with long and tortuous lesions, especially for those in which SES fails to pass through.

关 键 词：冠状动脉疾病 血管成形术 经腔 经皮冠状动脉 支架 

分 类 号：R543[医药卫生—心血管疾病]