冠状动脉弥漫性长病变的介入治疗

目的:评价冠心病患者应用长支架及多个支架序贯置入进行经皮冠状动脉介入治疗(PCI)的临床疗效。方法:对164例冠心病患者的284支靶病变血管进行了PCI,其中194支(68.3%)为弥漫性长病变,平均靶病变狭窄93.8%±8.7%。A组59例:1支靶病变血管置入单个长支架20~36mm;B组105例:至少1支靶病变血管为多个支架相连接(2~5个)。结果:A、B二组长病变置入支架的平均总长度分别为23.1±10.1mm,28.8±10.5mm(P<0.05);A、B组的PCI手术成功率均为100%,恢复TIMI 3级血流分别为93.6%、96.1%,手术即刻残余狭窄率分别为1.7%、2.1%,住院期间心血管病事件(MACE)发生率分别为3.4%、2.9%,二组间上述各项数值统计学无显著差异(P>0.05)。平均随访11.8个月,A组随访58例,MACE发生率为8.6%,无事件生存率为93.1%(54/58);B组随访101例,MACE发生率为11.9%,无事件生存率为83.8%(88/105),二组间比较,统计学无显著差异(P>0.05)。结论:冠心病患者的弥漫性长病变,应用长支架或多个支架序贯置入进行PC I,临床疗效均较好。

The interventional strategy for the long diffuse coronary stenosis: single long stent or multiple stents implantation

Objective: To compare the clinical effects of percutaneous coronary intervention with a long stent or multiple stents implantation in patients with long diffuse coronary stenosis.Methods: 164 patients with coronary artery disease undergoing PCI were recruited from Jan.2002 to Dec.2005.The PCI procedures were undertaken for 284 lesions.In 194(68.3%) long diffuse lesions,average stenosis was 93.8±8.7%.The single long stent group(Group A,stent length >20mm) included 59 patients with 90 stents(including 30 drug eluting stents,33.35%) implanted,and multiple stents group(Group B,stent length 19.5±5.5 mm) included 105 patients with 298 stents(including 97 DES,32.6%) implanted.The mean follow-up was 11.8 months.Results:The immediate success rate of PCI was 100%.TIMI 3 grade perfusion was reached in 93.6% and 96.1%,residual stenosis was 1.7% and 2.1%,the major adverse cardiac events(MACE) during hospitalization were found in 3.4% and 2.9% of patients in group A and B,respectively(all P>0.05).During the following-up,the free-of-symptom survival rates was 93.1%(54 of 58 patients) and 83.8%(88/105),and the MACE was 8.6% and 11.9% in group A and B,respectively(P>0.05).Conclusions: Both of single long stent and multiple stent implantations were effective and safe for the coronary artery disease with long diffuse coronary stenosis.During the following-up,the incidence of MACE in patients with long stent implantation was slightly lower than multiple stents implantation,but the trend doesn't reach statistical significance.