选择性左冠状动脉主干病变的介入治疗  

Primary stenting of unprotected left main coronary artery disease

作　　者：李绪刚[1,2] 王齐冰[1] 葛均波[1] 颜彦[1] 樊冰[1] 严卫[1] 钱菊英[1] 童步高[1] 蔡乃绳[1] 陈灏珠[1] 

机构地区：[1]复旦大学附属中山医院,上海市心血管病研究所,现200032 [2]山东省日照市人民医院心内科

出　　处：《中国介入心脏病学杂志》2001年第4期189-192,共4页Chinese Journal of Interventional Cardiology

摘　　要：目的　冠状动脉旁路移植术 (CABG)是多支血管病变血运重建的最佳方法 ,是无保护性左冠状动脉主干 (LMCA)病变的标准治疗。本研究探讨无保护性LMCA病变介入治疗的疗效和可行性。方法　总结分析 1996年 10月～ 2 0 0 0年 8月间 2 0例住院的冠心病左主干病变患者接受直接支架术治疗。入选患者例行左室造影 (LVEF >45 %) ,冠状动脉血管成形术及其疗效评判采用常规标准 ,合并右冠脉严重弥漫狭窄病变或前降支 (LAD)与回旋支 (LCX)同时严重狭窄者不行该术。结果　 2 0例中男 17例、女 3例 ,年龄 42～ 71(平均 6 4± 12 )岁 ,临床呈心绞痛Ⅱ Ⅲ级 ,其中合并高血压 9例、糖尿病 (2型 ) 1例。冠脉造影显示 ,左冠脉主干病变呈单纯狭窄者 8例 ,其中近中段狭窄 (5 0 %～ 80 %)者 6例、开口狭窄 (5 0 %～ 6 0 %)者 2例 ,左主干夹层分离者 2例 ,动脉瘤者 1例 ,合并LAD或LCX病变 (狭窄均 >70 %)者 9例 (狭窄 5 0 %～ 70 %)。全部患者左主干病变均进行直接支架术 ,其中 6例伴LAD或LCX病变者先行PTCA或支架术后再进行左主干病变的支架置入术。置入左主干内的支架均为管状宽径短支架 ,16例为 4 0mm× 9mm(直径×长度 )支架 ,3例为 3 5mm× 9mm支架 ,1例冠状动脉瘤者应用 4 5mm× 9mm支架。左主干支架术成功率为 10 0 %,无?Objective Update, coronary bypass surgery is the standard therapy of unprotected left main coronary artery (LMCA) disease Coronary angioplasty (PTCA) is performed only in bail out situations Recent reports suggested that stenting of LMCA diseases might be feasible This study was to evaluate its immediate and follow up outcomes Methods and Results From October 1996 to August 2000, 20 patients (17 males, 3 females, aged 64±12 years) with LMCA disease were treated primarily with stenting All patients presented with unstable angina (CCS grade II III) 8 patients had simple LMCA disease, of which 6 with proximal stenosis (50% 80%), 2 with ostial stenosis (50% 60%), 2 with dissection, 1 with aneurism 9 patients had LMCA stenosis (50% 70%) complicating left anterior descendens (LAD) or left circumflex (LCX) stenosis (all>70%) In all cases primary stenting of LMCA culprit stenosis was performed In 9 patients a PTCA of either LAD or LCX was performed prior to LMCA stenting The diameter～length of the stents used was 4 0 mm～9 mm in 16 patients, 4 5 mm～9 mm membraned stent in 1 patient of coronary aneurism Stent placement could be performed successfully in all patients, without remained stenosis and cardiac complications The patients were variably followed up for 1 4 years, angina disappeared in 14 patients, diminished markedly in 6 patients, and no serious cardiac events occurred 4 patients were found early restenosis on follow up angiography, of which 2 underwent bypass surgery, 2 performed repeat angioplasty Conclusion Thus, primary stenting of LMCA diseases is effective and feasible, and couldbe considered in selected patients as an alternative to coronary artery surgery

关 键 词：冠状动脉疾病 介入治疗 支架 

分 类 号：R54[医药卫生—心血管疾病]