自发性冠状动脉夹层的临床特点及腔内影像分析  

Clinical characteristics and intracavitary imaging analysis of spontaneous coronary artery dissection

作　　者：孟晓雪[1] 邢尔坤 朱友琦 药素毓[1] MENG Xiao-xue;XING Er-kun;ZHU You-qi;YAO Su-yu(Department of Cardiology,the First Hospital of Lanzhou University,Lanzhou 730000,China)

机构地区：[1]兰州大学第一医院心内科,甘肃兰州730000

出　　处：《中国介入心脏病学杂志》2023年第8期591-594,共4页Chinese Journal of Interventional Cardiology

基　　金：甘肃省自然科学基金项目(20JR10RA702);兰州大学第一医院2021年院内基金项目(ZX-62000002-2021-164)。

摘　　要：目的探讨自发性冠状动脉夹层(SCAD)的临床表现,夹层不同分型在腔内影像中的表现及治疗策略选择。方法纳入2021年8月至2022年8月以急性冠状动脉综合征收住于兰州大学第一医院心内科,经冠状动脉造影联合腔内影像检查[血管内超声(IVUS)或光学相干断层成像(OCT)]明确诊断SCAD的患者20例,收集相关临床资料,术后1~6个月通过门诊及电话随访,术后6个月复查冠状动脉造影联合腔内影像检查(IVUS或OCT),观察夹层及血肿吸收情况,有无新发病变出现及病变延展。结果SCADⅠ型5例(5/20),SCADⅡ型9例(9/20),SCADⅢ型4例(4/20),SCADⅣ型2例(2/20)。药物保护治疗13例(13/20,SCADⅡ型、Ⅲ型),行经皮冠状动脉介入治疗(PCI)7例(7/20,SCADⅠ型、Ⅳ型)。血肿入口和出口均出现明显夹层,血肿内可见斑块破裂,或有机化血栓形成,或SCADⅠ型、Ⅳ型,多采用PCI;血肿入口无夹层,血肿出口也无夹层的病变,管腔内未见斑块,血肿内部呈低回声,可采用药物保守治疗。患者平均随访6个月,药物保守治疗患者中再发急性心肌梗死1例(1/20)。结论SCAD通过腔内影像评估后确定夹层性质,选择适合的治疗策略,可以提高患者整体预后。Objective To investigate the clinical manifestations of spontaneous coronary artery dissection(SCAD),the diff erent types of dissection in intracavitary imaging and the choice of treatment strategies.Methods From August 2021 to August 2022,20 patients with SCAD who were diagnosed by coronary angiography combined with intracavitary imaging[intravascular ultrasound(IVUS)or optical coherence tomography(OCT)]were selected to live in our hospital with acute coronary syndrome.Relevant clinical data were collected.The patients were followed up by outpatient service and telephone from January to June after operation.The patients were re-examined by coronary angiography combined with intracavitary imaging(IVUS or OCT)at 6 months after operation to observe the absorption of dissection and hematoma,Whether there are new lesions and extension of lesions.Results There were 5 cases of SCAD typeⅠ(5/20),9 cases of SCAD typeⅡ(9/20),4 cases of SCAD typeⅢ(4/20)and 2 cases of SCAD typeⅣ(2/20).Conservative drug treatment in 13 cases(13/20,SCAD typeⅡand SCAD typeⅢ),and percutaneous coronary intervention(PCI)

关 键 词：冠状动脉夹层 急性冠状动脉综合征 血管内超声 光学相干断层成像 经皮冠状动脉介入治疗 

分 类 号：R541.4[医药卫生—心血管疾病]