冠心病分叉病变介入治疗中边支闭塞的预防及处理  

Prevention and management of side-branch occlusion in the percutaneous coronary intervention of bifurcation lesions

作　　者：王勇[1] 刘晓飞[1] 李宪伦[1] 曾玉杰[1] 石兵 施乐[1] 柯元南[1] 

机构地区：[1]中日友好医院心内科,北京100029 [2]新疆喀什市农三师医院,新疆喀什844000

出　　处：《中国心血管杂志》2006年第4期245-247,285,共4页Chinese Journal of Cardiovascular Medicine

摘　　要：目的 分析冠心病介入治疗中边支闭塞发生机制，并探讨其预防处理方法。方法 回顾性分析1999年～2004年350例冠心病分叉病变患者行介入治疗后并发边支闭塞的原因和处理过程。结果 在350例冠心病分叉病变中共有53例术中发生边支闭塞，发生率为15．1％。分叉病变部位：前降支和对角支处分叉病变29例，回旋支和钝缘支处分叉病变16例，左心室后侧支与后降支处分叉病变8例。闭塞边支血管直径〈2mm15例；直径2～2．5mm20例；直径〉2．5mm18例。分叉病变类型Ⅰ型2例；Ⅱ型12例；Ⅲ型39例。其中16例仅行药物治疗（闭塞边支血管直径〈2mm），14例行边支球囊扩张术，23例行边支支架置入术。术中1例发生急性左心功能衰竭，1例出现心源性休克。住院期间非Q波心肌梗死18例，Q波心肌梗死1例。无死亡、急诊冠状动脉旁路移植术（cABG）等其它并发症。结论冠心病分叉病变介入治疗中边支闭塞较为常见，其发生率约为15．1％，以Ⅲ型分又病变多见。常见原因为斑块移位、痉挛、血栓形成等所致。细小分叉病变可不必处理或予药物治疗，大的分支应积极介入治疗。Objective To analyse the mechanism of side-branch occlusion in the percutaneous coronary intervention （PCI）, and to explore its prevention and management. Methods From 1999 to 2004, reason and procedure of intercurrent sidebranch occlusion were analysed in PCI of 350 patients with bifurcation lesions retrospectively. Results Total 53 patients happened side-branch occlusion, with an incidence of 15.1% （53/350）. 29 bifurcation lesions were related to left anterior descending artery and diagonal branch artery. 16 bifurcation lesions were in left circumflex and obtuse marginal branch position. 8 bifurcation lesions located left posterior lateral artery and left posterior descending artery. Occlusive side-branch diameter was less than 2mm in 15 patients, from 2mm to 2.5mm in 20 patients, and more than 2.5mm in 18 patients. There were 2 type Ⅰ , 12 type Ⅱ, and 39 type Ⅲ. In 53 patients, 16 patients whose occlusive fide-branch diameter was less than 2mm received drug therapy, 14 patients did balloon coronary angioplasty, and 23 patients received side-branch stenting. 1 case occurred acute left heart dysfunction within operation. 1 patient happened cardiogenic shock. There were 18 non-Q-wave myocardial infarction and 1 Q-wave myocardial infarction in the period of in-hospital. No other serious complications such as death and emergency CABG happened. Conclusion Side-branch occlusion was relatively frequent, with an incidence of 15.1%, in which type m bifurcation lesion was primary. Frequent reasons included plaque shift, spasm and thrombosis. Thin side-branch occlusion may be either no management or only drug therapy, but big sidebranch occlusion performed PCI actively.

关 键 词：冠心病 经皮冠状动脉介入治疗 并发症 边支闭塞 

分 类 号：R541.4[医药卫生—心血管疾病]