直接冠状动脉支架置入术的临床应用及影响因素  

Direct coronary stenting without predilatation: clinical application, cost benefits and factors affecting success

作　　者：高传玉[1] Robert Whitbourn 

机构地区：[1]河南省人民医院,郑州450003 [2]DepartmentofCardiology,St.Vincent'sHospital,Australia

出　　处：《中华心血管病杂志》2001年第1期5-7,共3页Chinese Journal of Cardiology

摘　　要：目的　探讨选择性直接冠状动脉支架置入术应用的可行性及影响因素。方法　对 2 37例直接支架置入术患者的病变特点及临床预后进行了分析 ,并与 36 7例预扩张后支架置入术患者进行了比较。结果　对筛选的 2 5 4例患者尝试直接支架置入术 ,2 37例 (93 4% )获成功 ,其中A型病变5 2 7% ,B1型病变 40 1% ;17例 (6 7% )直接支架置入术失败 ,其中血管内超声肯定的钙化病变 7例 ,斑块纤维化 4例 ,血管严重成角 6例 (血管多个弯曲 >45°)。结论　对有经验的心脏介入医生筛选的病变 ,并避开钙化病变、严重成角血管和长病变 。Objective To assess the clinical application feasibility and affecting factors of direct stent implantation without balloon predilatation. Methods We studied a consecutive series of 604 patients underwent coronary stent procedures at a single centre and compared lesion characteristics, in hospital outcome, in laboratory equipment costs and radiation exposure parameters of direct stent implantation ( n =237) with the standard coronary stent implantation technique (predilatation before stent deployment, n =367). Results In 254 patients, direct stenting (without predilatation) was attempted and successfully deployed in 237 patients (93 3%), representing 39.2% of all stenting procedures. In direct stent group, 17 patients (6.7%) failed to implant the stent directly (7 patients had moderate vessel calcification, 6 patients had a very tortuous coronary, 4 patients had irregular plaque); 44 patients (18.6%), who had successful direct stenting, underwent further post dilatation with another balloon in order to achieve an optimal angiographic result. Lesions in the direct stenting group were predominantly type A (52.7%) and type B (40.1%). In standard stenting group, dominant lesions were type B (45.2%) and type C (39.6%). Compared to standard coronary stenting technique, there was no significant difference in number of stents used per patient (1.33±0.64 vs 1.43±0.65, P >0.05) or number of stented vessels per patient (1.10±0.33 vs 1.10±0.34, P >0.05). However, the direct stented patients required less expenditure on coronary interventional equipment (US$ 1 286.2±592.2 vs US$ 1 687.9±586.8, P < 0.001), used less contrast (239.7±86.4 ml vs 292.1±105.7 ml, P <0.001) and were exposed to less radiation dose (60.7±34.3 Gy vs 85.5±52.7 Gy, P <0.001) and X ray exposure time (10.6±7.0 min vs 16.3± 12.4 min, P <0.001). The major in hospital complications (death, Q MI, revascularization) were less in the direct group than that in standard coronary stenting group (0.4% vs 4.3%, P

关 键 词：血管成形术 经皮冠状动脉 支架置入术 临床应用 冠心病 

分 类 号：R541.4[医药卫生—心血管疾病]