russjcardiolРоссийский кардиологический журналRussian Journal of Cardiology1560-40712618-7620«SILICEA-POLIGRAF» LLC10.15829/1560-4071-2017-8-42-50russjcardiol-2458Research ArticleМЕТОДЫ ЛЕЧЕНИЯ И ДИАГНОСТИКИMETHODS OF TREATMENT AND DIAGNOSISЭФФЕКТИВНОСТЬ ПРИМЕНЕНИЯ СТЕНТОВ, ПОКРЫТЫХ СИРОЛИМУСОМ, ПРИ ЛЕЧЕНИИ ДИФФУЗНЫХ (ДЛИННЫХ И ОЧЕНЬ ДЛИННЫХ) АТЕРОСКЛЕРОТИЧЕСКИХ ПОРАЖЕНИЙ КОРОНАРНЫХ АРТЕРИЙEFFICACY OF SIROLIMUS ELUTING STENTS IMPLANTATION IN DIFFUSE (LONG AND EXTREMELY LONG) CORONARY ATHEROSCLEROTIC LESIONSБабунашвилиА. М.BabunashviliA. M.

д.м.н., заведующий отделением сердечно-сосудистой хирургии

Avtandil.babunashvili@gmail.comКарташовД. С.KartashovD. S.

заведующий операционным блоком

dima.kartashov@gmail.comБабокинВ. Е.BabokinV. E.

к.м.н., заведующий отделением кардиохирургии

babokin@bk.ruОзашвилиИ. Г.OzashviliI. G.

младший научный сотрудник отделения кардиохирургии

iozashvili@gmail.comЮдинИ. Е.YudinI. E.

научный сотрудник центра доказательной медицины

АО «Центр эндохирургии и литотрипсии»РоссияThe Center of Endosurgery and LithotripsyRussian FederationГБУЗ МО «Московский областной научно- исследовательский клинический институт им. М.Ф. Владимирского»РоссияMoscow Regional Research and Clinical Institute (MONIKI)Russian FederationФГАОУ ВО Первый МГМУ им. И.М. Сеченова Минздрава РоссииРоссияI.M. Sechenov First Moscow State Medical University of the Ministry of HealthRussian Federation201707102017084250Copyright © Бабунашвили А.М., Карташов Д.С., Бабокин В.Е., Озашвили И.Г., Юдин И.Е., 20172017Бабунашвили А.М., Карташов Д.С., Бабокин В.Е., Озашвили И.Г., Юдин И.Е.Babunashvili A.M., Kartashov D.S., Babokin V.E., Ozashvili I.G., Yudin I.E.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://russjcardiol.elpub.ru/jour/article/view/2458

Целью исследования явилась сравнительная оценка эффективности стентов, покрытых сиролимусом (I группа – 116 пациентов), и стентов без лекарственного покрытия (II группа – 117 пациентов) при лечении диффузных (длинных) атеросклеротических поражений коронарных артерии.

Материал и методы

Материал и методы: группы были сравнимы по основным признакам. Диабет отметили у 19% и 13,7%, многососудистые поражения 87,1% и 80,4%, калибр менее 2,75мм – 46,5% и 23,9%, соответственно. Длина поражения составила 25,9 ± 6,6мм (28-93мм) в I группе и 22,1 ± 7,8мм (26-102мм) во II группе. Всего имплантировано 473 стента в 232 артериях (2,1 стента на одну артерию): в I группе 184 стента в 116 артериях (наложение двух и более стентов 87,9% случаев) и 289 стентов в 117 артериях во II группе (суперпозиция стентов в 87,1% случаев).

Результаты

Результаты: непосредственный успех в ранние сроки отмечен у 113 пациентов в  I группе (97,4%) и у 116 пациентов во II группе (99,1%) (р=0,74).В обеих группах не наблюдали острый тромбоз стентов. Подострый тромбоз (в сроки 1-3 недели) отметили у 2 пациентов (1,7%) в I группе и у 1 (0,85%) во II группе (p=0,47). В отдаленном периоде ангиографический рестеноз наблюдали у 12 пациентов в I группе (10,6%) и у 66 во II группе (56,9%) (р<0,0025). При этом, во II группе у 47 пациентов из 66 отмечался диффузный рестеноз (71,2%), тогда как в I группе случаев диффузного рестеноза не было. Выживаемость без стенокардии и МАСЕ через 12 мес в I группе составила 79,8%, во II группе – 31%.

Aim

Aim. Comparison of efficacy of stents coated with sirolimus (group I — 116 patients), and bare metallic stents (group II — 117 patients) in treatment of diffuse (long) atherosclerotic lesions in coronary arteries.

Material and methods

Material and methods. The groups were comparable by main parameters. Diabetes was found in 19% and 13,7%, respectively; multivessel lesion in 87,1% and 80,4%; vessel caliber less than 2,75 mm — 46,5% and 23,9%, respectively. Length of the lesion was 25,9±6,6 mm (28-93 mm) in group I and 22,1±7,8 mm (26-102 mm) in group II. Totally, 473 stents implanted into 232 arteries (2,1 per artery): group I — 184 stents in 116 arteries (overlap of 2> stents in 87,9% cases) and 289 in 117 in group II (superposition of stents in 87,1%).

Results

Results. The direct success at short term was noted in 113 patients in group I (97,4%) and in 116 in group II (99,1%) (p=0,74). In both groups there were no cases of acute thrombosis of stents. Subacute thrombosis (in 1-3 weeks) was noted in 2 patients (1,7%) in group I and in 1 (0,85%) in group II (p=0,47). Long term angiographic restenosis was noted in 12 patients from group I (10,6%) and in 66 in group II (56,9%) (p<0,0025). Also, in group II 47 patients from 66 had diffuse restenosis (71,2%), as in group I there was no diffuse restenosis. Survival rate with no MACE or angina in 12 months was 79,8% in group I, and 31% in group II.

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The authors declare that there are no conflicts of interest present.