直接冠状动脉内支架植入术的可行性研究  

The study of the feasibility of direct coronary stenting

作　　者：杨震坤[1] 沈卫峰[1] 张大东[1] 张建盛[1] 张瑞岩[1] 张宪[1] 郑爱芳[1] 

机构地区：[1]上海第二医科大学附属瑞金医院心脏科,上海200025

出　　处：《临床心血管病杂志》2001年第11期494-496,共3页Journal of Clinical Cardiology

摘　　要：目的 :评价直接冠状动脉 (冠脉 )内支架植入术的安全性和可行性。方法 :对 1999年 12月～ 2 0 0 0年 6月接受冠脉内支架植入术的 171例患者中 ,孤立性、狭窄程度≤ 90 %、参考直径≥ 2 .5mm、长度≤ 18mm ;无明显的钙化、扭曲和成角 ,非完全闭塞和分叉处病变者 5 6例行直接冠脉内支架植入术。观察住院期和术后 3个月随访期内不良心脏事件的发生率。结果 :5 6例的 6 0处病变成功 5 5处 (91.7% ) ;1处因支架未能通过狭窄处而改行球囊预扩张后的支架植入术 ,1处在支架植入后因远端血管发生撕裂而需再植入 1个支架 ,3例因支架植入后冠脉造影显示支架扩张不满意而再用高压球囊扩张。住院期和术后随访期内无心源性死亡、心肌梗死、急诊冠脉旁路术发生 ;9例行冠脉造影复查 ,其中 2例因显示再狭窄而行再次经皮腔内冠脉成形术治疗。与经球囊导管预扩张后行冠脉内支架植入术相比 ,直接冠脉内支架植入术费用降低 2 9% ,造影剂用量减少 2 7% ,手术操作和X线照射时间缩短 2 6 %和 2 5 %。结论 :直接冠脉内支架植入术在经选择的病变中安全可行 ,并可降低手术费用 ,减少X线照射。Objective: This prospective study was designed to evulate the feasibility and safety of direct coronary stenting (without predilation) in selected coronary lesions. Method: Between December 1999 and June 2000, all patients (171 cases) who underwent coronary stent implantation were included. Direct coronary stenting (56 cases) was considered if the lesions met following criteria: single, subtotal occluded, nonbifurcated coronary artery lesion; stenosis≤90% and length≤18 mm, reference vessel diameter≥ 2.5 mm; absence of angiographically visible calcification and severe tortuosity. All patients were followed up for at least 3 months. Result: Direct coronary stenting was attempted in 60 lesions for 56 patients and was successfully performed in 55 lesions ( 91.7 %). No cardiac death, myocardial infarction and emergency coronary artery bypass graft occurred during hospitalization and follow up. Only two patients had revascularization because of restenosis. Compared with coronary stent implantation with predilation, the cost of direct coronary stenting was decreased by 29%, procedure and radiation exposure times were reduced by 26% and 25% respectively and the amount of contrast agent was decreased by 27%. Conclusion: Direct coronary stenting is effective and safe in selected lesions, associated with a decrease of the total cost.

关 键 词：冠心病 支架 直接植入 

分 类 号：R541.4[医药卫生—心血管疾病] R654.2[医药卫生—内科学]