经皮冠状动脉腔内成形术后再狭窄的临床特点和再成形治疗  

The Clinical Features of the Restenosis after Coronary Artery Angioplasty and the Efficacy of Repeat Angioplasty

作　　者：江洪[1] 黄从新[1] 唐其柱[1] 黎明江[1] 李建军[1] 王晋明[1] 许家俐[1] 漆曙辉[1] 王小红[1] 李庚山[1] 

机构地区：[1]湖北医科大学附属第一医院心内科,湖北省武汉市430060

出　　处：《中国循环杂志》2000年第1期4-6,共3页Chinese Circulation Journal

基　　金：湖北省"九五"攻关项目!962 P1 1 0 1

摘　　要：目的 :报道 3 14例经皮冠状动脉腔内成形术 ( PTCA)和支架置入 ( ICS)术后随访研究资料 ,评价术后再狭窄的临床特点和治疗。　　方法 :3 14例 PTCA( 2 4 7例 )和 ICS( 67例 )成功的病人术后随访 ,术后出现心绞痛症状者随时复诊并建议冠状动脉造影 ( SCA) ,无症状随访者 3～ 6个月复诊并建议 SCA。重度再狭窄或症状明显者施行再次 PTCA或 ICS治疗。　　结果 :3 14例中 182例 ( 5 8.0 % )保持随访 ,5 3例 ( 2 6例有症状 ,2 7例无症状 )复查 SCA。发现 :12 6例有症状者 SCA均有 1支或 1支以上的靶血管再狭窄 ,共 3 5支靶血管中 3 0支 ( 85 .7% )发生再狭窄 ;2 7例无症状者 8例有 1支或以上的靶血管再狭窄 ,共 3 7支靶血管中 10支发生再狭窄 ( 2 7.0 % )。 2 4 5例复查了运动试验 ,2 6例有症状者中 18例为阳性 ,SCA发现均有再狭窄 ( 10 0 .0 % ) ;2 7例无症状者 8例阳性 ,SCA6例有再狭窄 ( 75 .0 % ) ,另 19例阴性者 SCA2例见有再狭窄 ( 10 .5 % )。 3 5 3例 72支靶血管中 5 1支为 PTCA治疗 ,3 1支发生再狭窄 ( 60 .8% ) ,2 1支为 ICS治疗 ,9支发生再狭窄 ( 4 2 .9% )。 4 3 4例术后再狭窄的病人中 2 9例 ( 3 3支靶血管 )接受再次 PTCA或 ICS治疗 ,2 8例 ( 96.6% ) 3 2支( 97.0 % )靶血管获得成功。Objective:To evaluate the clinical features and the efficacy of repeated angioplasty of restenosis. Methods:Three hundred and fourteen patients treated successfully with percutaneous transluminal coronary angioplasty (PTCA,247cases) and intra coronary stenting (ICS,67cases) were followed up regularly and went to the hospital immediately for receiving selected coronary angiography (SCA)in those who had recurrence of angina pectoris or 3 to 6 months after procedure for receiving SCA.Patients with severe restenosis of target artery or with symptoms of angina were treated with repeated PTCA or ICS. Results:One hundred and eighty two of 314 patients (58 0%)were followed within 6 months after procedure and 53 of them (26 with and 27 without angina)were performed on SCA.It was found that:①Twenty six patients with angina had restenosis of one or more target arteries and 30 of 35 vessels in these patients had restenosis (85 7%),8 of 27 patients without angina had restenosis of one or more target arteries and 10 of 37 vessels in these patients had restenosis (27 0%);②Forty five patients performed treadmill tests,18 patients with angina had ischemic ST change and all of them (100 0%)had restenosis in SCA,8 of 27 patients without angina had ischemic ST change and 6 of them (75 0%) had restenosis in SCA,and 2 of 19 patients without angina and ischemic change (10.5%)had restenosis in SCA;③Seventy two vessels in 53 patients included 51 PTCA and 21 ICS,31 of 51 vessels after PTCA were restenosis (60.8%)and 9 of 21 after ICS were restenosis (42.9%);④Twenty nine of 34 patients were performed on repeated PTCA or ICS,28 patients (96.6%) and 32 of 33 target vessels (97 0%) were successfully performed. Conclusions:It was concluded that angina recurrence or ischemic ST change in treadmill is an important sign of severe restenosis in one or more vessels in patients after angioplasty and repeated PTCA or ICS may be safer with higher procedural success.

关 键 词：冠心病 血管成形术 PTCA ICS 再成形 

分 类 号：R654.2[医药卫生—外科学]