폐쇄성 말초혈관질환에서의 STENT 삽입술

Abstract

BACKGROUND: Efficacy of percutaneous transluminal angioplasty(PTA) in the treatment of Peripheral arterial disease has been established. Complications such ans PTA-induced dissections or residual stenosis with occasional mural thrombi have been reported, which compromise the results. New procedures can be used in combination with PTA to improve the immediate and long term results, such ans prolonged balloon inflation, atherectomy, or implantation of endovascular prosthesis. In addition, the occurrence of other lesions, such as spontaneous or post-catheterization dissection or post-PTA restenosis, has prompted the insertion of a vascular stent. But there was few reports on stenting for peripheral arterial disease in Korea. METHODS: To evaluate the safety, efficacy and stability of stent in peripheral arterial disease, twenty-six consecutive symptomatic patients with 37 peripheral lesions were treated with 39 balloon expandable(33 Strecker and 6 Palmaz)stents with or without prior balloon angioplasty in the period of March 1991 and February 1994. RESULTS: The major cause of disease was arteriosclerosis(22 out of 26). The implantation sites for our study include 22 in common iliac artery, 11 in external iliac artery 2 in aorta, subclavian artery, superficial femoral artery each other. Indication for stent deployment were primarily suboptimal results(19 lesions), insufficient PTA such as dissections(4), restenosis after previous PTA(2), and primary stenting was performed without preceding therapeutic PTA(10). Stent deployment was technically successful in 24 of the 26 patients(92%) and clinical success rate was in 25 of the 26 patients treated(96%). Hemodynamic change revealed markedly improvement before and after stenting(peak pressure difference from 66.329.0mmHg to 9.1+/-7.1mmHg; Mean pressure difference from 33.0+/-22.5mmHg to 4.7+/-4.3mmHg). There were two procedural complications which included one stent migration and one artery perforation. During the 7 months of follow-up(1-18 momths), two restenosis occurred. One patient died due to cerebral hemorrhage during thrombolysis with urokinase. CONCLUSION: The stent deployment is relatively safe and very effective primary therapeutic modality and may abolish the limitation of PTA such as suboptimal result, dissection with sudden occlusion and restenosis in peripheral vascular disease and highly recommended in selected cases.