Palmaz-Schatz stenting for treatment of focal vein graft stenosis: immediate results and long-term outcome.
Palmaz-Schatz stenting for treatment of focal vein graft stenosis: immediate results and long-term outcome.
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Palmaz-Schatz 支架置入术治疗局灶性静脉移植物狭窄：即时结果和长期结果。
DOI：
10.1016/0735-1097(94)90370-0
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发表时间：
1994
影响因子：
24
通讯作者：
CarrozzaJr,JP
中科院分区：
文献类型：
--
作者：
Piana,RN;Moscucci,M;Cohen,DJ;Kugelmass,AD;Senerchia,C;Kuntz,RE;Baim,DS;CarrozzaJr,JP
目标。本研究旨在评价Palmaz-Schatz支架置入术治疗隐静脉移植物狭窄的疗效。大隐静脉移植失败是冠状动脉搭桥术后再发缺血的常见原因。第二次搭桥手术比最初的手术风险更大，移植静脉的球囊血管成形术结果令人失望。希望START能提供更好的治疗选择。我们观察了200个隐静脉搭桥病变的支架置入结果，这些病变分别用冠状动脉支架(n=146)或胆道支架(n=54)治疗。对所有患者的即刻结果和临床随访(中位数15.5个月)进行了检查。为了记录血管造影结果，在3至6个月时，对第一批120个连续支架病变进行了第二次血管造影，其中94个病变获得了成功(78%)。移植物平均年龄(±SD)为8.7±4岁。支架置入成功率98.5%(197/200)，平均狭窄直径由74±14%降至1±15%。164例术中死亡1例(0.6%)，无急诊搭桥术，无Q波心肌梗死。急性支架血栓形成1例(0.6%)，无亚急性血栓形成。14例(8.5%)术后需要血管修复，另外23例(14%)需要输血。3~6个月血管造影再狭窄(直径狭窄≥50%)为17%(95%可信区间9%~25%)。然而，根据Kapian-Meier的估计，2年的第二次血管重建率为49%，反映了在其他部位治疗进展性疾病的主要血管重建术，因为支架部位的失败只发生在22%的病变中。在这组局灶性病变的、较老的大隐静脉移植物中，支架植入术导致了良好的即刻和长期的血管造影结果。尽管即刻成功率很高，6个月后血管造影再造率很低(17%)，但其中大约一半的患者需要在接下来的两年内进一步血运重建，主要是因为其他部位的疾病进展。
Objectives. This study aimed to evaluate the effectiveness of Palmaz-Schatz stenting for the treatment of saphenous vein graft stenoses.Background. Failure of saphenous vein grafts is a common cause of recurrent ischemia after coronary bypass surgery. A second bypass surgery carries more risk than the initial procedure, and balloon angioplasty of vein grafts has yielded disappointing results. It has been hoped that starting might offer a better treatment option.Methods. We examined the results of stent placement in 200 saphenous bypass graft lesions consecutively treated with either coronary (n = 146) or biliary (n = 54) Palmaz-Schatz stents. Immediate outcome and clinical follow-up (median 15.5 months) were examined in all patients. To document angiographic outcome, a second angiography was performed at 3 to 6 months for the first 120 consecutively stented lesions and was successfully obtained for 94 (78%).Results. The mean graft age (±SD) was 8.7 ± 4 years. Stent placement was successful in 197 (98.5%) of 200 lesions, reducing the mean diameter stenosis from 74 ± 14% to 1 ± 15%. In 164 procedures, there was one in-hospital death (0.6%), no emergency bypass operations and no Q wave myocardial infarctions. There was one acute stent thrombosis (0.6%) but no subacute thromboses. Vascular repair was required after 14 procedures (8.5%), with transfusion in 23 additional cases (14%). Angiographic restenosta (diameter stenosis ≥ 50%) at 3- to 6-month follow-up was 17% (95% confidence interval 9% to 25%). By Kapian-Meier estimates, however, the 2-year second revascularization rate was 49%, refecting the predominant revascularization performed to treat progressive disease at other sites because failure at the stented site occurred in only 22% of lesions.Conclusions. Stenting resulted in exellent immediate and long-term angiographic resuls in this group of focally diseased, older saphenous vein grafts. Despite the high immediate success and very low (17%) angiographic restenesis rate at 6 months, approximately one half of these patients required farther revascularization in the following 2 years, mainly because of disease progression at other sites.