慢性完全闭塞病变介入治疗诱发血管弥漫性夹层延迟干预的安全性分析  

A safety assessment of delayed intervention of diffuse coronary artery dissection caused by percutaneous coronary intervention in chronic total occlusion patients

作　　者：陆浩[1] 李晨光[1] 常书福[1] 戴宇翔[1] 黄东[1] 马剑英[1] 姚康[1] 张峰[1] 葛雷[1] 钱菊英[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,上海200032

出　　处：《中国介入心脏病学杂志》2015年第6期301-304,共4页Chinese Journal of Interventional Cardiology

基　　金：国家自然科学基金(81400318)

摘　　要：目的经皮冠状动脉介入治疗（percutaneouscoronaryintervention，PCI）慢性完全闭塞病变（chronictotalocclusion，CTO）可能导致冠状动脉弥漫性夹层形成，观察此类患者延迟支架置入的安全性、靶血管再闭塞发生率及预测因素，以及对再次PCI治疗成功率的影响。方法回顾性分析2009年2月至2013年8月在复旦大学附属中山医院进行CTO介入治疗时导致病变血管弥漫性夹层，并采用了延迟支架置入策略的患者19例，观察住院及随访期间心脏压塞、急性心肌梗死、死亡等并发症的发生率，夹层长度及TIMI血流分级对再闭塞的影响，比较原位闭塞及非原位闭塞患者再次PCI的成功率。结果所有患者住院及随访期间未发生心脏压塞、急性心肌梗死、死亡等并发症。术后6—50周复查冠状动脉造影示，靶血管再闭塞15例（78．9％），其中原位闭塞11例，非原位闭塞4例，首次PCI术后靶血管的TIMI血流均为I～Ⅱ级；血管再通4例，TIMI血流均为Ⅲ级。再次PCI的患者中，原位闭塞9例，正向PCI均失败，逆向PCI成功5例（55．6％）；非原位闭塞4例，正向PCI3例，逆向PCI1例，均成功；非原位闭塞再次正向PCI的成功率明显高于原位闭塞患者（P=0．003）。结论CTO介入治疗后出现弥漫性夹层，延期支架置入术是一种可选择的治疗方案，TIMI血流Ⅲ级是血管再通的独立预测因素，若出现原位再闭塞，在有可利用的侧支循环血管的情况下，应尽早选择逆向PCI策略以提高手术的成功率。Objective Percutaneous coronary intervention （PCI） can cause diffuse coronary artery dissection in chronic total occlusion （CTO） patients. The aim of our study was to evaluate the safety of ＂deferred＂ stent implantation, the rate of re-occlusion of target vessel and the success rate of re-PCI. Methods From Feb 2009 to Aug 2013, a total of 19 patients with CTO lesions suffered from diffused coronary artery dissection caused by PCI were enrolled in this study. All the 19 patients chose deferred PCI strategy. Complications such as pericardial effusion, acute myocardial infarction and death during hospitalization and follow-up period were documented. The rate of re-occlusion of target vessel and its relationship with the length of dissection and TIMI flow grade were analyzed. The success rate of re-PCI and the influence factors were also analyzed. Results All 19 patients had no complication of pericardial effusion, acute myocardial infarction or death during hospitalization and follow-up period. Re-occlusion Was observed in 15 （78. 9% ） patients 6-50 weeks after the index PCI. The target vessel of all the 15 patients had TIMI 1-2 flow grade in the index procedure, TIMI 3 flow was maintained in the rest 4 patients. Re-occlusion was not associated with the dissection length and the time interval of re-angiography. Of 15 re-occluded patients, 13 patients was treated with re-PCI. All 9 patients with original-site re-occlusion were failed to be treated with antegrade approach PCI, 3 out of 4 patients with non-original-site re-occlusion were successfully treated with anlegrade PCI. Non-original-sile re-occlusion patients had a higher successful rate with antegrade PCI （P〈 0.05 ） . Conclusions The present study suggests that deFErred stenting implantniml stralegy is safe in CTO patients with diffuse dissection caused by PCI. TIMI III flow is an independerlt iwedicalor for the maintain paleney of the larger vessel. If original-site re-occlusion occurred,retrograde approach may be the first choice if th

关 键 词：慢性完全闭塞病变 经皮冠状动脉介入治疗 血管夹层 

分 类 号：R541.4[医药卫生—心血管疾病]