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应用切割球囊结合支架术治疗冠状动脉分叉处病变89例(PDF)

《心脏杂志》[ISSN:1009-7236/CN:61-1268/R]

期数:
2003年第1期
页码:
20-22
栏目:
临床研究
出版日期:
2003-01-01

文章信息/Info

Title:
Application of cutting balloon angioplasty combined with stenting in eighty nine patients with coronary bifurcation lesions
作者:
韩雅玲; 臧红云; 荆全民; 王守力; 王冬梅; 王祖禄
沈阳军区总医院心内科,辽宁 沈阳110016
Author(s):
HAN Ya-ling; ZANG Hong-yun; JING Quan-min; WANG Shou-li; WANG Dong-mei; WANG Zu-lu
Department of Cardiology,General Hospital of Shenyang Command of PLA,Shenyang,Liaoning 110016,China
关键词:
经皮冠状动脉内切割球囊成形术; 分叉处病变; 冠状动脉疾病
Keywords:
percutaneous transluminal cutting ballon angioplasty; bifurcation lesions; coronary diseas
分类号:
R318.1;R62
DOI:
-
文献标识码:
A
摘要:
目的:评价经皮冠状动脉腔内切割球囊成形术(PTCBA)结合支架术治疗冠脉分叉处病变的安全性及疗效。方法:对89例冠心病患者主支病变应用PTCBA预扩张后置入支架、分支病变单行PTCBA而不置入支架,观察其冠脉病变特点、手术过程相关因素、手术成功率、并发症和近、中期随访结果。结果:89例患者中分叉处病变位于前降支/对角支占71%,回旋支/钝圆支占25%,右冠脉/后降支或后侧支占4%。对分支血管行PTCBA后1例因残余狭窄>50%而植入支架,1例因并发轻度钙化且分支成角较大切割球囊未通过,改用常规PTCA球囊扩张成功。病变PTCBA成功率达97.8%;无院内死亡、急性心肌梗死(AMI)、急性心包填塞及急诊冠脉搭桥术等严重并发症。对手术成功的87例术后临床随访3～26个月,无死亡及AMI等心脏事件发生。临床心绞痛复发率17.2%。复查冠脉造影(CAG)率56.3%,示49处分叉病变主支支架内再狭窄率14.3%,分支血管再狭窄率18.4%。结论:PTCBA结合支架术治疗冠脉分叉处病变是一种安全、有效的介入治疗技术,其成功率高、并发症少,近、中期疗效满意。
Abstract:
AIM: To evaluate the safety and efficacy of percutaneous transluminal cutting balloon angioplasty(PTCBA) combined with stenting in patients with coronary bifurcation lesions.METHODS:Eighty nine patients with coronary bifurcation lesions underwent stenting after PTCBA in their main vessles and PTCBA alone in side branches.The coronary lesion features,procedure related factors,success rate,severe complications and the result of follow-up were investigated respectively.RESULTS:Of the coronary bifurcation lesions in the 89 patients,71% were located in left anterior descending artery/diagonal branches,25% in circumflex artery/obtuse marginal branches,and 4% in right coronary artery/posterior descending artery or posterior lateral artery.There were 2 cases with PTCBA manipulation failure in side branch,who received conventional balloon dilation or stenting.The PTCBA success rate was 97.8%,and no in-hospital complications such as acute myocardial infarction(AMI),acute pericardial tamponade and emergency CABG occurred.During clinical following-up of 3～26 months,no severe cardiac events occurred such as death and AMI.Clinical recurrent angina rate was 17.2%.The repeated coronary angiography rate was 56.3%,and the restenosis rate of coronary angiography was 14.3% in main vessels and 18.4% in side branches.CONCLUSION:Stenting combined PTCBA in coronary bifurcation lesions is safe and effective in coronary interventional therapy with higher success rate,lower complication rate and better immediate and mid-term efficacy.

参考文献/References

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[2] Barath P,Fishbein MC,Vari S. Cutting balloon: a novel approach to percutaneous angioplasty [J] . Am J Cardiol, 1999, 68:1249.

[3] 马长生. 不同类型冠状动脉病变的介入治疗 [A] . 见:马长生, 盖鲁粤, 张奎俊. 介入心脏病学[M] . 北京:人民卫生出版社, 1998. 187-238.

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[5] Karvouni E, Mario CD, Nishida T. Directional atherectomy prior to stenting in bifurcation lesions:a matched comparison study with stending alone [J] .Catheter Cardiovasc Interv, 2001, 53:12-20.

[6] Caputo RP, Chafizadeh ER, Stoler RC. Stent jail: a minimum security prison [J] . Am J Cardiol, 1996, 77:1226-1229.

[7] Suwaidi Al, Berger J, Rihal CS. Immediate and long-term outcome of intracoronary stent implantation for true bifurcation lesions [J] . JACC, 2000, 35(4):929-936.

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[9] Nakamura M, Yamamoto M, Suzuki T. Cutting balloon angioplasty prior to stenting is useful strategy for the reduction of stent restenosis [J] . JACC, 1999, 33(supplJ):83A.

备注/Memo

备注/Memo:
收稿日期：2001-11-12.
更新日期/Last Update: 2003-01-01