冠状动脉长支架(≥20 mm)置入对慢性完全闭塞冠状动脉病变的短期和长期效果(摘要)
作者：韩雅玲 荆全民 王守力 王冬梅 苗志林
单位：辽宁省沈阳市，中国人民解放军沈阳军区总医院 心内科(110005)
关键词：
中国循环杂志99zk58 目的：对慢性完全闭塞冠状动脉病变(CTO)选择地置入支架是得到公认的，因为CTO病变经皮冠状动脉腔内成形术(PTCA)后的再狭窄较高。对弥漫性或长CTO病变如置入多个支架，不仅手术时间长且费用昂贵。我们对56例存在长CTO病变的CHD病人置入≥20 mm长冠状动脉支架57枚，以探索长冠状动脉支架对CTO病变的短期和长期效果。
方法：自1995年2月至1999年7月，我们成功地开通了138处CTO病变，其中119处病变(86.2%)应用冠状动脉支架术治疗。56例相继入院的病人(男性51例，平均年龄57.4±10.3岁)存在≥18 mm的CTO病变，其中1例存在两条CTO病变血管，其余者均为1支CTO病变血管。靶病变位于前降支(LAD)39例，右冠状动脉(RCA)10例，回旋支(LCX)8例。57处靶病变置入20～35 mm长支架57枚(Nir支架34枚，XT支架4枚，Multilink支架15枚，GRⅡ 2枚，Wallstent 2枚)。原位支架置入占54.4%(31处)，扩张结果不理想置入支架占33.3%(19处)，其余12.3%(7处)因PTCA时发生撕裂而置入支架。支架术后均口服噻氯匹定250 mg,每日2次,2～4周；阿司匹林300 mg,每日1次,4周。
, 百拇医药
结果：先用球囊导管对CTO病变进行充分预扩张，其后均成功置入长支架，病变狭窄程度从术前100%降至(7.9±3.1)%(-5%～10%,P<0.001)。平均最大支架扩张压力为12.1±1.4(10～16)大气压(atm)。7处撕裂病变经置入支架后均治愈。手术期间未发生血管痉挛、无再灌流及其他并发症，支架置入成功率为100%。支架术后平均随访24.6±16.9(1～53)个月，无心肌梗塞发生及死亡者。24例(42.9%)在术后4～15个月复查冠状动脉造影，其中7例(29.2%)在原病变部位发生再狭窄。再狭窄者中1例接受支架内再置支架术，5例支架内再次PTCA，1例接受冠状动脉旁路移植术(CABG)，均获成功。随访期间50例病人(89.3%)重复平板运动试验，其中47例(83.9%)为阴性结果；54例(96.4%)重复心脏超声检测，其中49例(87.5%)左心室内径较术前缩小，6例保持无变化。
结论：对CTO病变应用20～35 mm长的冠状动脉支架具有高手术成功率和低并发症发生率。术后再狭窄率低，主要心脏事件发生率低，长期随访发现绝大部分病人左心室内径缩小，踏车运动试验诱发的心肌缺血改善。
, 百拇医药
The Short and Long-Term Outcome of Long Coronary Stents (≥20 mm) in Chronic Total Occlusion Lesions (Abstract) (Abstract)
Department of Cardiology, General Hospital of Shenyang Military Command, Shenyang (110015), Liaoning
Han Yaling, Jin Quanmin, Wang Shouli, et al.
Objective: The use of elective stenting for chronic total occlusion (CTO) lesion is widely accepted because percutaneous transluminal coronary angioplasty (PTCA) in this subset of lesion is associated with high incidence of restenosis. Implantation of multiple stents in diffuse or long CTO lesions is time consuming as well as costly. We implanted 57 coronary stents ≥20 mm to 56 patients with long CTO lesions, to explore the short and long term outcome of long coronary stents in CTO lesions.
, http://www.100md.com
Methods: From February 1995 to July 1999, We successfully recanalized 138 CTO lesions, among them 119 lesions (86.2%) were treated with coronary stenting. Fifty-seven coronary stents ≥20 mm (34 Nir, 4 XT, 15 Multilink, 2 GRⅡ, and 2 wallstent) were inserted into 56 consecutive patients (51 males, mean age of 57.4±10.3 years) whose target vessels were diffuse and long CTO lesions. One patients had double CTO vessels and the others had single CTO. The target lesions were of LAD in 39, RCA in 10 and LCX in 8. DeNovo stent implantation accounted for 54.4% (31/57) of stenting and 33.3% (19/57) were for suboptimal results of ballooning, whilst the remainder 12.3% (7/57) were for coronary dissection happened in PTCA. After stenting, all patients took Ticlid 250 mg, Bid, for 2～4 weeks; Aspirin 250 mg, qd, for 4 weeks.
, 百拇医药
Results: All CTO lesions were fully pre-dilated by balloon catheter before stenting, and then all long stents were successfully deployed with reduction of lesion percentage stenosis from 100% to 7.9% (-5%～10%, p<0.001). The mean maximal pressure for stent expansion was 12.1±1.4 (10～16) ATM. Seven dissection lesions were healed by stenting. There were no vessel spasm, no-reflow and other complications during the procedure. Success rate of the stenting procedure was 100%. The mean follow-up period after stenting was 24.6±16.9 (1～53) months and there were no myocardial infarction and death during this time. Twenty four patients (42.9%) had follow up with angiography 4 to 15 months after stenting, of whom 7 patients (29.2%) had restenosis of the same lesions, and 1 of these patients received repeat instent stenting, 5 received repeat instent PTCA of the same lesions and 1 required coronary artery bypass graft (CABG). During follow up period, repeat treadmill exercise test was carriedout in 50 patients (89.3%) and 47 of them (83.9%) showed negative results. Repeat echocardiography was performed in 54 patients (96.4%) and the results showed that left ventricular sizes were smaller compared to the sizes of pre-stenting in 49 (87.5%) patients and kept unchanged in the remained 6.
, 百拇医药
Conclusion: The usage of long coronary stents (20～35 mm) in CTO lesions is associated with a high procedure success rate with low complication rate. After stenting, the restenosis rate is low and the main cardiac event rate is acceptable. The majority of patients obtained improvement both in left ventricular size and myocardial ischemia induced by treadmill exercise test during long-term follow up., http://www.100md.com
单位：辽宁省沈阳市，中国人民解放军沈阳军区总医院 心内科(110005)
关键词：
中国循环杂志99zk58 目的：对慢性完全闭塞冠状动脉病变(CTO)选择地置入支架是得到公认的，因为CTO病变经皮冠状动脉腔内成形术(PTCA)后的再狭窄较高。对弥漫性或长CTO病变如置入多个支架，不仅手术时间长且费用昂贵。我们对56例存在长CTO病变的CHD病人置入≥20 mm长冠状动脉支架57枚，以探索长冠状动脉支架对CTO病变的短期和长期效果。
方法：自1995年2月至1999年7月，我们成功地开通了138处CTO病变，其中119处病变(86.2%)应用冠状动脉支架术治疗。56例相继入院的病人(男性51例，平均年龄57.4±10.3岁)存在≥18 mm的CTO病变，其中1例存在两条CTO病变血管，其余者均为1支CTO病变血管。靶病变位于前降支(LAD)39例，右冠状动脉(RCA)10例，回旋支(LCX)8例。57处靶病变置入20～35 mm长支架57枚(Nir支架34枚，XT支架4枚，Multilink支架15枚，GRⅡ 2枚，Wallstent 2枚)。原位支架置入占54.4%(31处)，扩张结果不理想置入支架占33.3%(19处)，其余12.3%(7处)因PTCA时发生撕裂而置入支架。支架术后均口服噻氯匹定250 mg,每日2次,2～4周；阿司匹林300 mg,每日1次,4周。
, 百拇医药
结果：先用球囊导管对CTO病变进行充分预扩张，其后均成功置入长支架，病变狭窄程度从术前100%降至(7.9±3.1)%(-5%～10%,P<0.001)。平均最大支架扩张压力为12.1±1.4(10～16)大气压(atm)。7处撕裂病变经置入支架后均治愈。手术期间未发生血管痉挛、无再灌流及其他并发症，支架置入成功率为100%。支架术后平均随访24.6±16.9(1～53)个月，无心肌梗塞发生及死亡者。24例(42.9%)在术后4～15个月复查冠状动脉造影，其中7例(29.2%)在原病变部位发生再狭窄。再狭窄者中1例接受支架内再置支架术，5例支架内再次PTCA，1例接受冠状动脉旁路移植术(CABG)，均获成功。随访期间50例病人(89.3%)重复平板运动试验，其中47例(83.9%)为阴性结果；54例(96.4%)重复心脏超声检测，其中49例(87.5%)左心室内径较术前缩小，6例保持无变化。
结论：对CTO病变应用20～35 mm长的冠状动脉支架具有高手术成功率和低并发症发生率。术后再狭窄率低，主要心脏事件发生率低，长期随访发现绝大部分病人左心室内径缩小，踏车运动试验诱发的心肌缺血改善。
, 百拇医药
The Short and Long-Term Outcome of Long Coronary Stents (≥20 mm) in Chronic Total Occlusion Lesions (Abstract) (Abstract)
Department of Cardiology, General Hospital of Shenyang Military Command, Shenyang (110015), Liaoning
Han Yaling, Jin Quanmin, Wang Shouli, et al.
Objective: The use of elective stenting for chronic total occlusion (CTO) lesion is widely accepted because percutaneous transluminal coronary angioplasty (PTCA) in this subset of lesion is associated with high incidence of restenosis. Implantation of multiple stents in diffuse or long CTO lesions is time consuming as well as costly. We implanted 57 coronary stents ≥20 mm to 56 patients with long CTO lesions, to explore the short and long term outcome of long coronary stents in CTO lesions.
, http://www.100md.com
Methods: From February 1995 to July 1999, We successfully recanalized 138 CTO lesions, among them 119 lesions (86.2%) were treated with coronary stenting. Fifty-seven coronary stents ≥20 mm (34 Nir, 4 XT, 15 Multilink, 2 GRⅡ, and 2 wallstent) were inserted into 56 consecutive patients (51 males, mean age of 57.4±10.3 years) whose target vessels were diffuse and long CTO lesions. One patients had double CTO vessels and the others had single CTO. The target lesions were of LAD in 39, RCA in 10 and LCX in 8. DeNovo stent implantation accounted for 54.4% (31/57) of stenting and 33.3% (19/57) were for suboptimal results of ballooning, whilst the remainder 12.3% (7/57) were for coronary dissection happened in PTCA. After stenting, all patients took Ticlid 250 mg, Bid, for 2～4 weeks; Aspirin 250 mg, qd, for 4 weeks.
, 百拇医药
Results: All CTO lesions were fully pre-dilated by balloon catheter before stenting, and then all long stents were successfully deployed with reduction of lesion percentage stenosis from 100% to 7.9% (-5%～10%, p<0.001). The mean maximal pressure for stent expansion was 12.1±1.4 (10～16) ATM. Seven dissection lesions were healed by stenting. There were no vessel spasm, no-reflow and other complications during the procedure. Success rate of the stenting procedure was 100%. The mean follow-up period after stenting was 24.6±16.9 (1～53) months and there were no myocardial infarction and death during this time. Twenty four patients (42.9%) had follow up with angiography 4 to 15 months after stenting, of whom 7 patients (29.2%) had restenosis of the same lesions, and 1 of these patients received repeat instent stenting, 5 received repeat instent PTCA of the same lesions and 1 required coronary artery bypass graft (CABG). During follow up period, repeat treadmill exercise test was carriedout in 50 patients (89.3%) and 47 of them (83.9%) showed negative results. Repeat echocardiography was performed in 54 patients (96.4%) and the results showed that left ventricular sizes were smaller compared to the sizes of pre-stenting in 49 (87.5%) patients and kept unchanged in the remained 6.
, 百拇医药
Conclusion: The usage of long coronary stents (20～35 mm) in CTO lesions is associated with a high procedure success rate with low complication rate. After stenting, the restenosis rate is low and the main cardiac event rate is acceptable. The majority of patients obtained improvement both in left ventricular size and myocardial ischemia induced by treadmill exercise test during long-term follow up., http://www.100md.com