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|本期目录/Table of Contents|

植入覆膜支架的Ⅲ型冠状动脉穿孔分布特征与原因及其疗效

《心脏杂志》[ISSN:1009-7236/CN:61-1268/R]

期数:
2017年第5期
页码:
544-546,551
栏目:
临床研究
出版日期:
2017-03-25

文章信息/Info

Title:
Distribution characteristics and the reasons and curative effects of type III coronary artery perforation with the covered stents implantation
作者:
王小明1; 2; 刘 毅1; 陶 凌1
（1.第四军医大学第一附属医院心血管内科，陕西 西安 710032；
2.成都军区机关第三门诊部，云南 昆明 650021）
Author(s):
WANG Xiao-ming1; 2;  LIU Yi1;  TAO Ling1
（1.Department of Cardiology, Xijing Hospital, Fourth Military Medical University, Xi’an 710032, Shaanxi, China；
2.Third Outpatient Department of Chengdu Military Command, Kunming 650021, Yunnan, China）
关键词:
覆膜支架; 冠状动脉穿孔; 经皮冠状动脉介入术
Keywords:
covered stent;  coronary artery perforation;  percutaneous coronary intervention
分类号:
R541.4
DOI:
-
文献标识码:
A
摘要:
目的 分析植入覆膜支架的Ⅲ型冠状动脉穿孔的分布特征、原因及效果。 方法 回顾性分析有记录的植入覆膜支架的Ⅲ型冠脉穿孔病例。结果 冠状动脉穿孔植入覆膜支架28（男20，女8）例，年龄45~85（66±8）岁；穿孔血管分别为前降支20例（71%），右冠状动脉6例（21%），回旋支2例（7%）；穿孔部位血管病变分型分别为A型病变16例（57%），C型病11例（39%），B2型病变1例（4%）,CTO 6例（21%），严重钙化病变10例（36%），心肌桥3例（11%）；穿孔的原因分别为支架球囊后扩张15例（54%），支架释放6例（21%），后扩张球囊后扩张3例（11%），预扩张球囊扩张1例（4%），导丝3例（11%）。穿孔后有17例（61%）发生心包填塞。24例（86%）植入覆膜支架的患者封堵成功，6例患者紧急外科开胸探查，其中4例行急诊冠状动脉旁路移植术。住院期间死亡3例（11%），术中和住院期间发生主要心血管不良事件的患者9例（32%）。有7例患者进行了造影随访，70%以上的狭窄有3例。结论 植入覆膜支架的Ⅲ型冠状动脉穿孔以A型病变为主，穿孔的原因主要是支架球囊后扩张，覆膜支架为封堵穿孔有效办法，但覆膜支架再狭窄率高。
Abstract:
AIM The aim of this study was to analyse the distribution characteristics and the reasons and curative effects of patients with type III coronary perforation who planted covered stent during percutaneous coronary intervention. METHODS Retrospective analysis of recorded patients with type III coronary artery perforation with the covered stents implantation. RESULTS Coronary artery perforation with the covered stents implantation 28 cases (male 20, female 8), the average age is 45-85(66±8) years old. The perforation arteries are LAD 20 cases (71%), LCX 2 cases (7%) and RCA 6 cases (21%), respectively; The lesion type of perforation arteries are type A 16 cases (57%), type C 11 cases (39%), type B2 1 case (4%), CTO 6 cases (21%), severe calcification 11 cases (36%) and myocardial bridge 3 cases (11%), respectively; The causes of perforation are post-expansion with stents balloon 15 cases (54%), stents expansion 6 cases ( 21%), post-expansion with post-expansion balloon 3 cases (11%), and guidewire (11%), respectively. The rate of pericardial tamponade is 61%. The success rates of sealing the rupture site by covered stent is 86%。The in-hospital mortality and major adverse cardiac event rate are 11% and 32%, respectively. 7 cases are followed with CAG, and more than 70% of the stenosis in 3 cases. CONCLUSION The lesion type of type III coronary perforation with covered stents is mainly type A and the mainly cause of perforation is post-expansion with stents balloon. The covered stent is an effective way to seal the rupture site with a high success rate but a high restenosis rate.

参考文献/References

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[4]Shimony A,Zahger D,Van Straten M,et al.Incidence, risk factors,management and outcomes of coronary artery perforation during percutaneous coronary intervention[J].Am J Cardiol,2009,104(12):1674-1677.
[5]Al-Lamee R,Ielasi A,Latib A,et al.Incidence, predictors,management,immediate and long-term outcomes following grade III coronary perforation[J].JACC Cardiovasc Interv,2011,4(1):87-95.
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备注/Memo

备注/Memo:
收稿日期：2016-11-13.
基金项目：国家自然科学基金项目资助（81400201，81170186，81470478）
通讯作者：陶凌，主任医师，主要从事糖尿病心肌损伤研究 Email:lingtao@fmmu.edu.cn
作者简介：王小明，硕士生 Email:406925019@qq.com
更新日期/Last Update: 2017-04-20