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目的评价雷帕霉素洗脱支架(商品名Cypher支架,强生公司产品)治疗支架内再狭窄的疗效及安全性。方法27例支架内再狭窄且有临床缺血症状的患者接受了Cypher支架治疗,其中23例患者的支架内再狭窄为弥漫、复杂病变,有5例同时置入了2个Cypher支架。术后对所有患者进行临床随访及冠状动脉造影复查。结果所有支架均成功置入,无残余狭窄或残余狭窄<10%,未见任何并发症。平均随访时间8.9±2.1(5～14)年,临床随访率96.3%,造影随访率92.6%。随访期间,无一例患者死亡。有1例支架近端边缘节段血管发生了再狭窄导致临床心绞痛复发,2例支架近端边缘节段有轻微的新生内膜增殖,但狭窄程度<25%,其余24例均无明显的晚期管腔丢失。本组支架内平均晚期管腔丢失(0.09±0.02)mm、支架远端边缘节段(0.10±0.03)mm、支架近端边缘节段(0.20±0.06)mm。靶血管血运重建率3.8%。结论Cypher支架治疗支架内再狭窄安全、可行,它能有效防止这类病变的新生内膜增殖和再次再狭窄。
Objective To evaluate the efficacy and safety of rapamycin-eluting stent (brand name Cypher stent and Johnson & Johnson) in the treatment of in-stent restenosis. Methods Twenty-seven patients with stent restenosis and clinical ischemic symptoms underwent Cypher stenting. Twenty-three of the patients had diffuse and complicated in-stent restenosis, and 5 had two Cypher stents simultaneously. All patients underwent clinical follow-up and coronary angiography. Results All stents were successfully placed without any residual stenosis or residual stenosis <10% without any complications. The average follow-up time was 8.9 ± 2.1 (ranged from 5 to 14) years, with a clinical follow-up rate of 96.3% and a follow-up rate of 92.6%. During the follow-up period, none of the patients died. There was a case of re-stenosis in the proximal segment of the scaffold, which resulted in the recurrence of clinical angina. In 2 cases, the proximal segment of the scaffold had slight neointimal hyperplasia but the stenosis was less than 25%, while the remaining 24 cases had no obvious advanced stage Lost cavity. The average late stent loss in this group was (0.09 ± 0.02) mm, the distal edge of the stent was 0.10 ± 0.03 mm, and the proximal edge of the stent was 0.20 ± 0.06 mm. Target vessel revascularization rate 3.8%. Conclusion The Cypher stent is safe and feasible for the treatment of in-stent restenosis. It can effectively prevent neointimal hyperplasia and restenosis of such lesions.