即兴支架术对冠状动脉无保护简单左主干分叉病变患者的临床疗效  

The therapeutic effect of provisional stenting in patients with unprotected simple left main bifurcation lesions of cortical artery

作　　者：王硕 战吟戈 郑庆厚[2] 陈勤聪 王乐[2] 李柳[2] WANG Shuo;ZHAN Yinge;ZHENG Qinghou;CHEN Qincong;WANG Le;LI Liu(Department of Cardiology,Shijiazhuang People’s Hospital,Shijiazhuang 050031;Department of Cardiology,Hebei Medical University First Hospital,Shijiazhuang 050011,China)

机构地区：[1]石家庄市人民医院心内科,河北石家庄050031 [2]河北医科大学第一医院心内科,河北石家庄050011

出　　处：《西安交通大学学报（医学版）》2024年第6期941-947,共7页Journal of Xi’an Jiaotong University（Medical Sciences）

基　　金：河北省卫生健康委员会重点科技研究计划资助(No.20241849)。

摘　　要：目的探讨即兴支架术(provisional stenting,PS)在冠状动脉无保护简单左主干分叉病变患者中应用的安全性和有效性,并观察该术式对患者心功能、心肌损伤、心肌灌注的影响。方法回顾性分析在河北医科大学第一医院心内科住院行PS术式并完成3个月随访的无保护简单左主干分叉病变患者82例。所有患者均完善术前检查,术前及术后3个月行静息动态单光子发射计算机断层扫描系统(dynamic single-photon emission computed tomography,D-SPECT)+瑞加诺生负荷D-SPECT检查,观察手术的安全性评价指标,包括支架植入即刻成功率以及是否发生急性支架内血栓、冠脉无复流、分支受累、分支急性闭塞、急性左心衰、心脏传导阻滞、心脏压塞、大出血、死亡;有效性评价指标包括术前及术后血管内超声(intravenous ultrasound,IVUS)测得的冠状动脉左主干最小管腔面积(minimum lumen area,MLA),术前及术后1 d、7 d、1个月、3个月的心功能指标[脑钠肽(brain natriuretic peptide,BNP)、左心室射血分数(left ventricular ejection fraction,LVEF)、左心室舒张末期内径(left ventricular end diastolic diameter,LVEDD)]、心肌损伤指标[肌酸激酶同工酶-MB(creatine kinase isoenzyme-MB,CK-MB)、肌钙蛋白Ⅰ(cardiac troponinⅠ,cTnⅠ)];心肌灌注评价指标包括术前以及术后3个月应用静息D-SPECT+瑞加诺生负荷D-SPECT检查心肌17节段分布下心肌灌注总积分、心肌缺血总节段数。结果安全性指标观察显示:支架植入即刻成功率100%、回旋支受累行球囊对吻扩张19例(23.1%),分支急性闭塞1例,后行双支架术,应用PS-T(provisional stenting-T stenting)术式;无发生急性支架内血栓、冠脉无复流、急性左心衰、心脏传导阻滞、心脏压塞、大出血、死亡病例。有效性指标观察显示:术后IVUS测得的MLA较术前明显改善;自术后7 d开始,BNP、CK-MB、cTnⅠ较术前明显改善。心肌灌注指标观察显示:术�Objective To explore the safety and effectiveness of provisional stenting(PS)applied in patients with unprotected simple left main bifurcation lesions,and to observe the impact of this procedure on cardiac function,myocardial injury,and myocardial perfusion.Methods A retrospective analysis was made on 82 patients with unprotected simple left main bifurcation lesions who underwent elective stenting and completed a 3-month follow-up in the Department of Cardiology,Hebei Medical University First Hospital.All the patients underwent preoperative examinations,including rest dynamic single-photon emission computed tomography(D-SPECT)and regadenoson stress D-SPECT before and 3 months after surgery.The safety evaluation indicators for the surgery included immediate success rate of stent implantation,acute stent thrombosis,coronary no-reflow,branch involvement,branch acute occlusion,acute left heart failure,heart block,cardiac tamponade,major bleeding,and mortality.The effectiveness evaluation indicators included the minimum lumen area(MLA)of the left main trunk of coronary artery measured by intravenous ultrasound(IVUS)before and after surgery,as well as cardiac function indicators[brain natriuretic peptide(BNP),left ventricular ejection fraction(LVEF),left ventricular end diastolic diameter(LVEDD)]and myocardial injury indicators[creatine kinase isoenzyme-MB(CK-MB),cardiac troponinⅠ(cTnⅠ)]at day 1,day 7,1 month,and 3 months before and after surgery.The myocardial perfusion evaluation indicators included the total myocardial perfusion score and total ischemic segment number under the 17-segment distribution of myocardial perfusion using rest D-SPECT and regadenoson stress D-SPECT before and 3 months after surgery.Results Safety indicators:immediate success rate of stent implantation(100%),19 cases(23.1%)of circumflex branch involvement that underwent balloon anastomosis dilation,1 case of acute branch occlusion,followed by double stent surgery using provisional stenting-T stenting(PS-T)technique.There were no cases of

关 键 词：动态单光子发射计算机断层扫描(D-SPECT) 冠状动脉无保护简单左主干分叉病变 即兴支架术(PS) 心肌灌注 

分 类 号：R541.4[医药卫生—心血管疾病]