药物洗脱支架治疗无保护左主干病变  

Drug-eluting stent implantation for unprotected left main coronary artery disease:immediate and long-term outcomes

作　　者：张励庭[1] 袁勇[1] 黄炫生[1] 冯力[1] 刘卫其[1] 韩莹[1] 张劲[1] 邓志华[1] 董剑廷[1] 

机构地区：[1]中山市人民医院心内科,广东中山528403

出　　处：《南方医科大学学报》2008年第12期2257-2259,共3页Journal of Southern Medical University

摘　　要：目的评价药物洗脱支架治疗冠状动脉无保护左主干（ULMCA）病变的安全性及疗效。方法选择2002年10月-2007年11月我院收治经冠状动脉造影证实为无保护左主干病变患者44例；合并心功能不全（左室射血分数〈40％）5例，肺功能减退2例，慢性肾功能不全5例；常规行冠状动脉造影及经皮冠状动脉介入治疗。分析其冠脉造影特征、手术成功率及临床随访结果。结果44例患者经皮冠状动脉介入治疗即刻成功率为100％，无严重术中并发症，手术住院期间的病死率、非致死性心肌梗死率及急诊常规行冠状动脉造影率均为0％。所有患者均植入药物洗脱支架。术后平均随访14．2±9．3月（6--65月），所有患者均未发生亚急性或延迟性支架内血栓形成；6例（13．6％）患者有心绞痛症状复发；1例患者在术后4个月因心力衰竭死亡；37例（84．1％）患者无严重不良心血管事件发生。35例（79．5％）患者进行了冠状动脉造影复查，其中冠状动脉造影复查提示发生再狭窄3例（8．6％）：1例为左主干远端分叉病变，分叉处再狭窄转外科行常规行冠状动脉造影术；2例左主干末端分叉病变分支开口发生再狭窄，使用切割球囊再次经皮冠状动脉介入治疗后，症状缓解。结论对选择性的冠状动脉左主干病变使用药物洗脱支架行介入治疗安全有效。近、远期疗效良好。Objective To evaluate the safety and efficacy ofdrug-eluting stentt （DES） implantation in selective patients with left main coronary artery disease. Methods From October 2002 to November 2007, 44 consecutive patients underwent percutaneous coronary interventions （PCI） on left main coronary artery lesions, including 5 patients with concurrent left ventricular dysfunction （ejection fraction〈40%）, 2 with chronic respiratory dysfunction and 5 with chronic renal failure. The findings in coronary angiography, procedural success rate, severe complications and the follow-up results of the patients were analyzed. Results The immediate procedtwal success rate was 100% in these patients without any severe complications. No non-fatal acute myocardial infarction or emergency coronary artery bypass grafting （CABG） was performed and death occurred in none of the cases during hospitalization. In the follow-up period for 14.2±9.3 （6-65） months after PCI, no subacute or late thromboses were found. One patient died from heart failure 4 months after PCI, and 6 patients （13.6%） experienced recurrent angina. Thirty-seven patients （84.1%） were free of any major cardiovascular events （MACE） after the procedure. A repeat coronary angiography was performed in 35 patients （79.5%） within 6 months after PCI, and 3 （8.6%） of them were confirmed to have restenosis, including 1 patient with distal bifurcation restenosis who were subsequently treated with CABG and two patients with side-branch ostium restenosis managed with cutting balloon dilation. Conclusion Implantation of drug-eluting stents is safe and effective for management of left main coronary artery disease with good immediate and long-term outcomes.

关 键 词：冠状动脉 无保护左主干 血管成形术 

分 类 号：R543[医药卫生—心血管疾病]