药物洗脱支架治疗血管痉挛性心绞痛患者固定性狭窄的疗效  

Clinical and angiographic outcomes of coronary drug-eluting stenting in treating vasospastic angina patients with severe organic stenosis

作　　者：黄浙勇[1] 钱菊英[1] 杨虹波[1] 徐磊[1] 戴宇翔[1] 李晨光[1] 仲昕[1] 张峰[1] 姚康[1] 马剑英[1] 黄东[1] 刘学波[1] 颜彦[1] 葛雷[1] 樊冰[1] 王齐兵[1] 葛均波[1] 

机构地区：[1]复旦大学附属中山医院心内科上海市心血管病研究所,200032

出　　处：《中华心血管病杂志》2012年第7期560-564,共5页Chinese Journal of Cardiology

摘　　要：目的观察药物洗脱支架治疗血管痉挛性心绞痛患者严重固定性狭窄的疗效。方法在2006年1月至2010年12月期间诊断血管痉挛性心绞痛的46例患者中，冠状动脉造影显示血管固定性狭窄≥70％、置入药物洗脱支架的患者共7例（15．2％）。对这7例患者进行冠状动脉造影随访和临床随访，观察支架术的疗效。结果7例患者共置人9枚药物洗脱支架，支架直径2．75—3．50（3．08±0．24）mm，长度24—33（27．3±3．6）mm。其中5例（71．4％）患者在左前降支置入支架，1例（14．3％）患者在右冠状动脉置人支架，1例（14．3％）患者在左前降支和右冠状动脉均置人支架。2例患者在左前降支置人支架过程中分别出现暂时性右冠状动脉痉挛和左前降支远端痉挛；1例患者在左前降支支架置人术后24h出现静息性胸痛，伴V1-V3导联ST段一过性抬高。术后6～18个月复查冠状动脉造影，2例（28．6％）患者无支架内再狭窄和内膜增生，2例（28．6％）患者支架内轻度内膜增生，3例（42．9％）患者发生支架内或支架边缘再狭窄。临床随访17～50个月，2例（28．6％）患者无症状，3例（42．9％）患者出现静息性心绞痛，1例（14．3％）患者反复发作劳力性心绞痛和静息性心绞痛，1例（14．3％）患者发作劳力性心绞痛。结论药物洗脱支架治疗合并严重固定狭窄的血管痉挛性心绞痛疗效有限，支架内再狭窄、再发心肌缺血症状的发生率较高。Objective To evaluate the clinical and angiographic outcomes of vasospastic angina patients with severe organic stenosis treated by drug-elnting stents. Methods Between January 2006 and December 2010, severe organic stenosis （ diameter stenosis more than 70% ） was evidenced in 7 out of 46 vasospastic angina patients and treated with drug-eluting stents. Coronary angiography was repeated at 6 - 18 months after percntaneous coronary intervention and the patients were clinically followed up. The clinical and angiographic outcomes were observed. Results Nine drug-eluting stents [ mean diameter 2. 75 - 3.50 （3.08 ＋ 0. 24） ram, length 24 - 33 （ 27.3 ＋ 3.6 ） mm] were successfully implanted in these 7 patients. Stents were implanted into left anterior descending artery （LAD） in 5 patients （71.4%）, right coronary artery （RCA） in 1 patient （14. 3% ）,both LAD and RCA in 1 patient （14. 3% ）. Transient RCA spasm and distal LAD spasm were observed during percutaneous coronary intervention of LAD in 2 patients. Anginal attack at rest with transient ST segment elevation at Vl - V3 leads occurred 24 hours after LAD stenting in 1 patient. Follow-up coronary angiography showed significant in-stent restenosis or focal edge restenosis （diameter stenosis more than 50% in 3 patients （42. 9% ）, mild neointimal proliferation but without significant restenosis in 2 patients 28.6% ）, and no neointimal proliferation in 2 patients （28.6%）. During clinical follow-up of 17 to 50 months after percutaneous coronary intervention, 2 patients （28.6%） remained asymptomatic, while effort angina and/or rest angina was documented in the remaining 5 patients （71.4%）. Conclusions Our results from this small patient cohort suggest that drug eluting stent implantation for severe organic stenosis in patients with vasospastic angina is linked with high incidence of restenosis and recurrent chest pain. Further observation in larger patient cohort is warranted to clarify the efficacy of this strategy for

关 键 词：冠状动脉疾病 支架 治疗结果 

分 类 号：R541.4[医药卫生—心血管疾病]