冠状动脉内长和短支架及多个支架置入后再狭窄的血管造影随访研究

目的　比较单个短和长支架及多个支架置入的远期血管造影再狭窄发生率。方法　回顾性分析1996年5月至1998年10月在我院接受冠状动脉内支架置入并有血管造影随访的77例病人的临床及血管造影资料。单个短支架组（A组支架长度≤20mm）37例,39支血管；单个长支架组（B组支架长度>20mm）22例，25支血管；多个支架组（C组）18例，18支血管置入39个支架。结果　　病变长度在B和C组明显长于A组［（23.66±12.78)mm和(26.42±13.60)mm与(10.30±4.67)mm，P<0.001］；支架长度C组>B组>A组,P<0.001和0.002。随访时最小管腔开放直径(MLD)和管腔晚期丢失在A和C组间有明显差异，P<0.01和0.02，而在A和B组，B和C组间无统计学差异。三组的再狭窄率分别为28.2%、36%和61.1%，C组明显高于A组（P<0.05）,而B组又高与A组、C组高于B组的趋势，但统计学上无明显差异。Logistic多因素回归分析证实多个支架置入是再狭窄的唯一的独立预测因素（OR=3.29,P<0.05）。结论　多个冠状动脉内支架置入是发生晚期血管再狭窄的唯一独立预测因素；而与单个短支架置入相比，单个长支架置入的再狭窄率也有增高的趋势。

Restenosis after short, long and multiple coronary stents implantation: clinical and angiographic follow-up

Objective　This study was undertaken to compare the incidence of restenosis in single short stents and, long and multiple stents implantation. Methods　77 patients who underwent successful coronary stent implantation and 6 months follow-up coronary angiography were divided into three groups: the single short stentgroup (Group A, stent length <20 mm) included 37 patients with 39 vessels involved; the single long stent group (Group B, stent length >20 mm) included 22 patients with 25 vessels involved; the multiple stent group (Group C) included 18 patients with 18 vessels involved. Results　The mean follow-up periods, pre-stent reference vessel diameter and minimal luminal diameter (MLD), post-stent MLD, the acute gain, the stent diameter, the stent/vessel ratio, and the maximal balloon inflation pressure were not significantly different between the three groups. Lesion were longer in groups B and C compared to group A ［(23.66±12.78)mm and (26.42±13.60)mm vs(10.30±4.67)mm, P<0.001］. Stents in group B were longer than in group A (31.24±7.25)mm vs (16.49±2.26)mm, P<0.001), stents in group C were longer compared to group B (41.56±13.54)mm vs (31.24±7.25)mm, P<0.002). During follow up, MLD and late loss were significantly different between groups A and C (1.91±0.91)mm vs (1.22±0.87)mm P<0.01 and (1.21±0.83)mm vs (1.74±0.79)mm P<0.02), but not significantly different between groups A and B ［MLD (1.70±0.93)mm, late loss (1.34±0.94)mm］ and, B and C. The restenosis rate was significantly higher in group C compared to group A (61.1% vs 28.2%, P<0.05). It tended to be higher in group B compared to group A and in group C compared to group B, but was not statistically different. Logistic regression analysis revealed multiple stent implantation to be the only independent predictor of restenosis (OR=3.29, P<0.05). Conclusion　Multiple stent implantation is the only independent predictor of late restenosis. Compared with short stents implantation, long stents tend to increase the restenosis rate.