雷帕霉素药物涂层支架(CYPHER^(TM))治疗前降支长病变的临床研究  

The clinical study of CYPHER ^(TM) stent in long lesion of left anterior descending artery

作　　者：王伟民[1] 吴淳[1] 韩雅君[1] 刘健[1] 赵明中[1] 

机构地区：[1]北京大学人民医院心内科,100044

出　　处：《中国介入心脏病学杂志》2003年第5期242-244,共3页Chinese Journal of Interventional Cardiology

摘　　要：目的　评价雷帕霉素药物涂层支架 (CYPHERTM ,Codis)治疗前降支长病变的临床效果。方法　我院在 2 0 0 2年 10月至 2 0 0 3年 4月的 6 5例冠心病患者置入CYPHERTM 支架 (Cordis)治疗 ,对 5 3例前降支病变置入CYPHERTM 支架 6 5个 ,其中 4 2例为长病变 (病变长度≥ 2 0mm) ,病变长度 2 0～ 5 0mm[(2 8 2± 8 8)mm],术前病变狭窄程度 88 9%± 8 5 % ;血管直径 (3 0± 0 9)mm。 3例慢性闭塞病变。 2例支架内再狭窄。其中 12例前降支病变 >35mm ,置入 2个支架重叠 ;30例为 1个长支架覆盖病变。观察药物涂层支架的手术成功率、术中并发症、住院期间及 1～ 6个月随访期间的心绞痛、心肌梗死、猝死、再次血管重建等发生。结果　手术即刻成功率 10 0 % ,术后造影病变残余狭窄 5 0 %±4 8% ,支架完全覆盖病变 ,支架近、远端无新夹层 ,血流TIMI 3级。 1例术后 38h因胸痛心肌梗死冠脉造影证实为支架内血栓形成。临床随访 1～ 6个月 38例患者心绞痛消失 ,4例心绞痛症状减轻。其中 8例术后 3～ 6个月复查冠状动脉造影 ,无血管再狭窄。结论　雷帕霉素药物涂层支架(CYPHERTM)治疗前降支长病变是安全有效的 ;短期临床随访结果明显优于既往报告前降支普通支架置入的临床结果。Objective To evaluate the clinical effect of CYPHER TM (rapamycin) stent in treatment of left anterior descending (LAD) long lesion. Methods From October 2002 to April 2003, 65 patients with coronary heart disease (CAD) were treated with CYPHER TM (Cordis) stent and 65 stents were planted in 53 LAD lesions. Among the patients with LAD lesions, 42 cases were long lesions (≥20 mm). The length of lesion was from 20 mm to 50 mm (28.2±8.8 mm), the degree of stenosis before procedure was 88.9%±8.5%, and the vessel diameter before procedure was 3.0±0.9 mm. Three lesions were chronic total occlusion (CTO) lesion. Two lesions were in-stent restenosis. 12 lesions over 35 mm long were treated with two overlapped stents to cover the whole lesion. 30 lesions were treated with only one stent. We observed the procedure success and complication rates. The occurance of angina, myocardial infarction, sudden death, and the revascularization rate during the in-hospital and 6 months follow up. Results Immediate procedure success rate was 100% with residual stenosis of 5.0%±4.8%. All the lesions were covered fully by stents and the coronary flow reached TIMI grade three. No new dissection was observed in the optimal of stents. Only one patient was diagnosed as myocardial infarction after procedure and in-stent thrombolysis was proved by coronary artery angiography (CAG). During the 6 months follow-up, the symptom of angina was disappeared in 38 patients and alleviated in 4 patients. Eight patients received CAG in 3-6 months and no restenosis was observed. Conclusion Drug eluting stent (CYPHER TM) implantation is a safe and efficient therapy in treating patients with LAD long lesion, and short term follow-up results were better than the general coronary stents.

关 键 词：雷帕霉素 药物涂层支架 前降支长病变 临床研究 再狭窄 血管重建 

分 类 号：R815[医药卫生—放射医学] R543[医药卫生—临床医学]