自制覆膜支架在冠状动脉穿孔封堵治疗中的应用  

Application of homemade polyurethane-covered stent for treatment of coronary artery perforations

作　　者：张涛[1] 张宇晨[1] 冯婷婷[1] 王旭[1] 王志坚[1] 孙伟[2] 李学鹏 赵林[1] ZHANG Tao;ZHANG Yu-chen;FENG Ting-ting;WANG Xu;WANG Zhi-jian;SUN Wei;LI Xue-peng;ZHAO Lin(Department of Cardiology,Beijing Anzhen Hospital,Capital Medical University,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院心内科,北京100029 [2]中国中医科学院望京医院心内科 [3]首都医科大学研究生院

出　　处：《中国介入心脏病学杂志》2023年第3期195-200,共6页Chinese Journal of Interventional Cardiology

基　　金：国家自然科学基金项目(81670391);北京市医管局培育基金(PZ2021008);首都卫生发展科研基金(2022-2-1052)。

摘　　要：目的评价自制覆膜支架在冠状动脉穿孔封堵治疗中的有效性和安全性。方法回顾性观察2016年1月至2022年6月首都医科大学附属北京安贞医院行经皮冠状动脉介入治疗术中发生急性冠状动脉穿孔的患者15例,术中使用自制覆膜支架进行封堵治疗。分析患者的临床基本资料、病变特点、封堵治疗、住院期间及术后主要不良事件。结果15例患者中男6例,女9例,平均年龄(64.3±4.6)岁,合并高血压病者8例,9例冠状动脉穿孔分布于左前降支,病变类型中慢性完全闭塞病变有5例、钙化病变7例,穿孔类型以EllisⅢ型居多共10例。13例患者术中使用自制覆膜支架封堵成功,成功13例(13/15)。2例自制覆膜支架置入失败者转入心外科急诊开胸手术,其中1例因术后大面积脑梗死死亡,1例患者急性支架内血栓形成导致死亡。2例患者晚期支架内血栓形成。结论使用自制覆膜支架封堵冠状动脉穿孔是安全、有效的治疗方式,对于无市售覆膜支架或心外科支持的介入中心更值得推广。Objective To investigate the safety and efficiency of polyurethanecovered stent for treatment of coronary artery perforations.Methods From January 2016 to June 2022,fifteen patients with coronary artery perforations who underwent homemade polyurethane-covered stents implantation were retrospectively observed in our study.Clinical data,angiographic and procedure characteristics details were analyzed.Complications and major adverse cardiovascular events(MACE)were also documented.Results Among the fifteen patients,nine were female,with an average age of(64.3±4.6)years.There were eight patients with hypertension.Coronary artery perforations were distributed in LAD of nine patients.Chronic total occlusion(CTO)(5 cases)and calcified rotary atherectomy(7 cases)lesions occupy the majority.Ten cases of perforation were typeⅢof Ellis grade.Homemade polyurethane-covered stents were successfully implanted in thirteen patients(13/15).Two patients who failed implantation were transferred to undergo cardiac surgery,and one of them died of massive cerebral infarction after operation.One patient died of acute stent thrombosis,and two patients were observed to suffered late stent thrombosis.Conclusions Application of homemade polyurethane-covered stent for treatment of coronary artery perforations is a safe and efficient method.It is worthy of promotion especially in those intervention centers without commercial covered-stent or cardiac surgery support.

关 键 词：自制覆膜支架 冠状动脉穿孔 经皮冠状动脉介入治疗 

分 类 号：R541[医药卫生—心血管疾病]