当代临床实践中的支架失败管理
Iosif Xenogiannis1, Charalampos Varlamos1, Despoina-Rafailia Benetou1
1Second Department of Cardiology, Attikon University Hospital, National and Kapodistrian University of Athens, Chaidari, 12461 Athens, Greece.
Diagnostics (Basel, Switzerland)
|July 12, 2025
概括
经过皮肤冠状动脉干预 (PCI) 的患者中,大约有9%的患者经历了支架衰竭 (SF),表现为支架静止症或支架血栓形成. 用药物涂层的气球是SF病例新型支架植入的常见替代方案,特别是支架复缩.
科学领域:
- 心脏病学 心脏病学
- 干预心脏病学 干预心脏病学
- 血管医学 血管医学
背景情况:
- 当代支架技术已经进步,但支架失败 (SF),包括支架复原 (ISR) 和支架血栓 (ST),仍然是一个临床挑战.
- SF影响了皮肤穿冠状动脉干预 (PCI) 后的显著比例的患者.
研究的目的:
- 为了比较临床特征,表现,血管检查结果和SF患者的治疗,与接受PCI的新发病变相比较.
- 确定SF管理的基本机制和程序策略.
主要方法:
- 观察性,单中心研究,将101例SF病例与接受PCI治疗新发病变的患者进行比较.
- 分析基线特征,临床表现,手术干预和血管内成像发现.
主要成果:
- 在1120名PCI患者中,SF发生在9%的患者中;75%的患者有ISR,25%的患者有ST.
- SF患者的糖尿病,脂质失调和先前的绕道手术率较高,目前吸烟率较低.
- 药物涂层气球 (44%) 和普通气球血管整形 (8.9%) 在SF病例中使用的频率更高,相比新发病变 (分别为5.3%和0.7%).
- 在SF组中,冠内成像的使用率更高 (33%对13%).
- 支架错位和新动脉样硬化分别是ST和ISR的关键机制.
- 程序成功率是可比的 (96%对98%).
结论:
- 大约十分之一的PCI患者经历了支架失败.
- 冠内成像在管理SF中发挥着至关重要的作用.
- 虽然输出药物的支架植入是de novo病变的标准,但药物涂层气球是ISR的首选选择.
- 干预性心脏病专家必须掌握静脉内成像解释,以获得最佳的SF治疗结果.
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