目的：置入冠状动脉内支架一般包括对靶病变部位用球囊进行预扩张和支架后加压扩张，我们初步报道未经球囊预扩张而直接置入冠状动脉内支架，支架后扩张使用相同的支架球囊。

方法：28例患者放置了28个支架，包括24例男性和4例女性患者，年龄52.9±9.7岁，10例患者有陈旧性心肌梗塞病史，5例有近期心肌梗塞史，6例为稳定性心绞痛，6例为不稳定性心绞痛，以及1例无症状但运动试验阳性者。病变类型分为：A型12例，B1型11例，B2型5例，支架放置前狭窄程度为(73.6±4.5)%。支架后管腔残余狭窄程度为(0.53±2.08)%。平均支架长度为13.6±3.6 mm。

结果：所有病例直接将带球囊的支架送至未经预扩张的病变部位，支架放置成功率为100%，无并发症发生。随诊30天所有患者无不良反应。5例进行随访造影，其中3例患者发生再狭窄。

结论：成功率高与以下病变特征有关：①病变无或轻度钙化；②靶病变部位前轻至中度弯曲；③病变的类型仅限于A型和B型；④置入支架前血流为心肌梗塞溶栓治疗临床试验(TIMI)3级；⑤病变长度越短越好。直接置入支架的优点包括：缩短了曝光时间，减少造影剂的使用，降低费用。

Direct Intra-Coronary Stenting without Balloon Predilation (Abstract)

Division of Coronary Heart Disease, Cardiovascular Institute and Fu Wai Hospital, CAMS and PUMC, Beijing (100037)

Qiao Shubin, Gao Runlin, Chen Jilin, et al.

Objective: Coronary stent implantation includes balloon and post-stent dilation of the target lesion. We here report our initial experience with direct intracoronary stent deployment without balloon predilation.

Methods: Post-dilation was done using the same stent balloon. Twenty-eight patients underwent implantation of 28 stents, including 24 men and 4 women, aged 52.9±9.7 years. Ten patients were with old myocardial infarction (OMI), 5 with recent MI, 6 with stable angina and 6 with unstable angina; the last one was asymptomatic but with positive exercise test. Lesion type distribution: type A (12), type B1 (11) and type B2 (5). Pre-stenting stenosis was (73.6±4.5)%. Post-stenting residual stenosis decreased to (0.53±2.08)%. Average stent length was 13.6±3.6 mm.

Results: In all cases the stent crossed the lesion without predilation, stent deployment was successful in 100% of the cases. There were no complications. The following 30-day follow-up was uneventful in all of the patients. Coronary angiography was repeatedly done for 5 cases, only 3 patients (10.3%) had restenosis.

Conclusion: Certain lesion characteristics were associated with high success rate: ① No or mild calcification in the lesion; ② Mild to moderate tortuosity of the segment before target lesion; ③ Complexity of lesion limited to type A & B; ④ Pre-stenting TIMI flow 3; ⑤ The shorter the lesion, the better the stenting result. The advantages of direct stenting include shorter fluoroscopy time, less radiopaque dye used as well as better cost-ettectiveness.