未预扩直接冠状动脉支架置入术的即刻及长期效果(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(110015)
关键词：
中国循环杂志99zk60 目的：用球囊导管行预扩张是以往冠状动脉支架置入术术前的必需步骤。我们对21例冠心病病人未行预扩张、直接置入冠状动脉支架21枚，以观察直接冠状动脉支架置入术的安全性和效果。
方法：1997年2月至1999年7月，对本科21例病人置入预装Nir-primo冠状动脉支架21枚。病人中男性17例，女性4例，平均年龄55.4±10.2岁，其中10例患有稳定性心绞痛，9例为不稳定性心绞痛，2例为急性心肌梗塞(AMI)发病6 h以内者。靶病变为前降支15例，右冠4例，回旋支2例，所有靶病变均位于病变血管的近端或中段。平均靶病变狭窄程度为(73.1±4)%(70%～80%)。根据AHA/ACC指南，靶病变复杂程度相对较简单：A型病变8例，B1型病变10例，B2型病变3例。病变处本身或其近端无钙化及显著弯曲。Nir-primo支架的长度为9～25(平均15.4)mm,直径为2.5～4.0(平均3.1)mm。平均手术时间27.2±4.6(20～35)min支架术后所有病人服用噻氯匹定250 mg,2次/日，共2～4周；阿司匹林300 mg,1次/日，共4周；2例AMI病人术后静脉滴注肝素每小时800～1 000 U，共72 h。
, 百拇医药
结果：未行球囊预扩张，21枚Nir支架均顺利推送至病变处，并均被成功扩张。平均最大扩张压力为12.1±1.5(10～16)atm,其中16例≤12 atm。平均支架扩张时间为23.1±6.6(10～30)s,仅对5例行扩张后高压(>12 atm)整形。置入支架后，靶病变平均狭窄减少至(0.5±4.7)%(-5%～10%)。直接冠状动脉支架术中无撕裂、痉挛及其他并发症，手术即刻成功率100%。所有病人术后心绞痛均消失。术后平均住院日3.7±1.8(2～9)天，非AMI病人为3.2±1.0(2～5)天。术后随访1～29(平均10.4±9.5)个月，无AMI、不稳定性心绞痛及死亡者，仅1例术后5个月心绞痛复发。13例在支架术后3～14个月复查冠状动脉造影，仅1例术后心绞痛复发者证实有再狭窄，对其成功进行了支架内再次PTCA。
结论：对恰当选择的冠状动脉病变行直接冠状动脉支架术具有较高的即刻成功率和满意的长期效果。这种操作方法的优点是降低病人费用，缩短手术时间及X线暴光时间。此外，直接冠状动脉支架术后再狭窄率有降低趋势，其可能的机制是减少球囊预扩张造成的冠状动脉损伤和撕裂。
, 百拇医药
Immediate and Long-Term Results of Primary Coronary Stenting without Pre-Dilation (Abstract)
Department of Cardiology, General Hospital of Shenyang Military Command, Shenyang (110015), Liaoning
Han Yaling, Jin Quanmin, Wang Shouli, et al.
Objective: Pre-dilation by coronary balloon catheter was a traditional necessary procedure for coronary stent implantation. We directly implanted 21 coronary stents to 21 coronary heart disease (CHD) patients without pre-dilation, in order to observe the safety and the effect of primary coronary stenting.
, 百拇医药
Methods: From February 1997 to July 1999, We implanted 21 premounted Nir-primo coronary stents directly without pre-dilation to 21 CHD patients (17 males and 4 females, mean age of 55.4±10.2 years) in our department. Ten patients had stable angina, 9 had unstable angina and 2 had AMI whose symptom appeared less than 6 hours. The target lesions were of LAD in 15 cases, RCA in 4 and LCX in 2. All target lesions located in proximal or middle part of the target vessels. The average percentage stenosis of the lesions was (73.1±4.0)% (70%～80%), and the lesions were relatively simple according to AHA/ACC guidelines: Type A in 8, type B1 in 10 and type B2 in 3. There were no calcification and obvious tortuosity within the lesion segments perseor in proximal part of the lesions. The length and the diameter of the Nir-primo stents implanted were 9～25 (15.4 in average) mm and 2.5～4.0 (3.1 in average) mm, respectively. The mean operation time was 27.2±4.6 (20～35) min. After coronary stenting, all patients took Ticlid 250 mg, twice daily for 2～4 weeks, as well as Aspirin 300 mg per day for 4 weeks; 2 acute myocardial infarction (AMI) patients received heparin intravenously 800～1 000 U per hour for 72 hours.
, 百拇医药
Results: We smoothly pushed 21 stents into the lesion locations and then expanded all of the stents successfully without balloon pre-dilation. The maximal pressure for stent expansion was 12.2±1.5 atm in average (10～16 atm) and less than or equal to 2 atm in 16 cases. The mean stent dilation time was 23.1±6.6 (10～30) sec. and high pressure (>12 atm) post-dilation was performed in only 5 cases. There were no dissection, spasm and other complications during stenting procedure, and the immediate operation success rate was 100%. After coronary stenting, the average percentage stenosis of target lesions decreased to 0.5±4.7% (-5%～10%) and all patients had no angina. The mean post-operation hospital stay was 3.7±1.8 (2～9) days for all patients and 3.2±1.0 (2～5) days for non-AMI patients. We have been following up these patients 1～29 months (10.4±9.5 months in average) and found no AMI, unstable angina and death among them, except 1 patient had reangina 5 months after the procedure. Thirteen patients received repeat coronary angiogram 3～14 months after stenting operation and only one who had re-angina revealed restenosois by angiogram and then received instent repeat percutaneous transluminal coronary angioplasty (PTCA) successfully.
, 百拇医药
Conclusion: Primary coronary stenting technique has higher immediate success rate and satisfactory long-term effect to suitably selected coronary lesion, and the method has the advantages of lowering patient expense, and shortening the time of operation and X-ray exposure. Besides, there seems to be a tendency of decreased restenosis rate after primary coronary stenting, by the possible mechanism of less coronary damage and dissection which could be produced during balloon pre-dilation., 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(110015)
关键词：
中国循环杂志99zk60 目的：用球囊导管行预扩张是以往冠状动脉支架置入术术前的必需步骤。我们对21例冠心病病人未行预扩张、直接置入冠状动脉支架21枚，以观察直接冠状动脉支架置入术的安全性和效果。
方法：1997年2月至1999年7月，对本科21例病人置入预装Nir-primo冠状动脉支架21枚。病人中男性17例，女性4例，平均年龄55.4±10.2岁，其中10例患有稳定性心绞痛，9例为不稳定性心绞痛，2例为急性心肌梗塞(AMI)发病6 h以内者。靶病变为前降支15例，右冠4例，回旋支2例，所有靶病变均位于病变血管的近端或中段。平均靶病变狭窄程度为(73.1±4)%(70%～80%)。根据AHA/ACC指南，靶病变复杂程度相对较简单：A型病变8例，B1型病变10例，B2型病变3例。病变处本身或其近端无钙化及显著弯曲。Nir-primo支架的长度为9～25(平均15.4)mm,直径为2.5～4.0(平均3.1)mm。平均手术时间27.2±4.6(20～35)min支架术后所有病人服用噻氯匹定250 mg,2次/日，共2～4周；阿司匹林300 mg,1次/日，共4周；2例AMI病人术后静脉滴注肝素每小时800～1 000 U，共72 h。
, 百拇医药
结果：未行球囊预扩张，21枚Nir支架均顺利推送至病变处，并均被成功扩张。平均最大扩张压力为12.1±1.5(10～16)atm,其中16例≤12 atm。平均支架扩张时间为23.1±6.6(10～30)s,仅对5例行扩张后高压(>12 atm)整形。置入支架后，靶病变平均狭窄减少至(0.5±4.7)%(-5%～10%)。直接冠状动脉支架术中无撕裂、痉挛及其他并发症，手术即刻成功率100%。所有病人术后心绞痛均消失。术后平均住院日3.7±1.8(2～9)天，非AMI病人为3.2±1.0(2～5)天。术后随访1～29(平均10.4±9.5)个月，无AMI、不稳定性心绞痛及死亡者，仅1例术后5个月心绞痛复发。13例在支架术后3～14个月复查冠状动脉造影，仅1例术后心绞痛复发者证实有再狭窄，对其成功进行了支架内再次PTCA。
结论：对恰当选择的冠状动脉病变行直接冠状动脉支架术具有较高的即刻成功率和满意的长期效果。这种操作方法的优点是降低病人费用，缩短手术时间及X线暴光时间。此外，直接冠状动脉支架术后再狭窄率有降低趋势，其可能的机制是减少球囊预扩张造成的冠状动脉损伤和撕裂。
, 百拇医药
Immediate and Long-Term Results of Primary Coronary Stenting without Pre-Dilation (Abstract)
Department of Cardiology, General Hospital of Shenyang Military Command, Shenyang (110015), Liaoning
Han Yaling, Jin Quanmin, Wang Shouli, et al.
Objective: Pre-dilation by coronary balloon catheter was a traditional necessary procedure for coronary stent implantation. We directly implanted 21 coronary stents to 21 coronary heart disease (CHD) patients without pre-dilation, in order to observe the safety and the effect of primary coronary stenting.
, 百拇医药
Methods: From February 1997 to July 1999, We implanted 21 premounted Nir-primo coronary stents directly without pre-dilation to 21 CHD patients (17 males and 4 females, mean age of 55.4±10.2 years) in our department. Ten patients had stable angina, 9 had unstable angina and 2 had AMI whose symptom appeared less than 6 hours. The target lesions were of LAD in 15 cases, RCA in 4 and LCX in 2. All target lesions located in proximal or middle part of the target vessels. The average percentage stenosis of the lesions was (73.1±4.0)% (70%～80%), and the lesions were relatively simple according to AHA/ACC guidelines: Type A in 8, type B1 in 10 and type B2 in 3. There were no calcification and obvious tortuosity within the lesion segments perseor in proximal part of the lesions. The length and the diameter of the Nir-primo stents implanted were 9～25 (15.4 in average) mm and 2.5～4.0 (3.1 in average) mm, respectively. The mean operation time was 27.2±4.6 (20～35) min. After coronary stenting, all patients took Ticlid 250 mg, twice daily for 2～4 weeks, as well as Aspirin 300 mg per day for 4 weeks; 2 acute myocardial infarction (AMI) patients received heparin intravenously 800～1 000 U per hour for 72 hours.
, 百拇医药
Results: We smoothly pushed 21 stents into the lesion locations and then expanded all of the stents successfully without balloon pre-dilation. The maximal pressure for stent expansion was 12.2±1.5 atm in average (10～16 atm) and less than or equal to 2 atm in 16 cases. The mean stent dilation time was 23.1±6.6 (10～30) sec. and high pressure (>12 atm) post-dilation was performed in only 5 cases. There were no dissection, spasm and other complications during stenting procedure, and the immediate operation success rate was 100%. After coronary stenting, the average percentage stenosis of target lesions decreased to 0.5±4.7% (-5%～10%) and all patients had no angina. The mean post-operation hospital stay was 3.7±1.8 (2～9) days for all patients and 3.2±1.0 (2～5) days for non-AMI patients. We have been following up these patients 1～29 months (10.4±9.5 months in average) and found no AMI, unstable angina and death among them, except 1 patient had reangina 5 months after the procedure. Thirteen patients received repeat coronary angiogram 3～14 months after stenting operation and only one who had re-angina revealed restenosois by angiogram and then received instent repeat percutaneous transluminal coronary angioplasty (PTCA) successfully.
, 百拇医药
Conclusion: Primary coronary stenting technique has higher immediate success rate and satisfactory long-term effect to suitably selected coronary lesion, and the method has the advantages of lowering patient expense, and shortening the time of operation and X-ray exposure. Besides, there seems to be a tendency of decreased restenosis rate after primary coronary stenting, by the possible mechanism of less coronary damage and dissection which could be produced during balloon pre-dilation., http://www.100md.com