郑亚国,许田,陈亮,单守杰,林松,张俊杰,陈绍良

• 1:南京市第一医院南京医科大学附属南京医院心内科

摘要(Abstract)：

目的回顾性分析自发性冠状动脉夹层(spontaneous coronary artery dissection,SCAD)患者的发病特点和腔内影像学特征,探讨血管内超声(intravenous ultrasound,IVUS)和光学相干断层成像(optical coherence tomography,OCT)在其诊断和治疗中的应用价值。方法回顾性分析2012年8月至2018年3月南京市第一医院经IVUS或OCT确诊为SCAD的17例患者,借助SCAD冠状动脉造影分型对病变进行分类,分析不同类型SCAD患者影像学特点及临床随访事件。结果 17例SCAD患者中,临床表现为急性ST段抬高型心肌梗死7例(7/17),非ST段抬高型心肌梗死5例(5/17),不稳定型心绞痛5例(5/17)。冠状动脉造影病变累及左前降支14例(14/17),左回旋支2例(2/17),右冠状动脉1例(1/17)。SCAD分型示Ⅰ型2例(2/17),Ⅱ型10例(10/17),Ⅲ型5例(5/17)。17例患者中,10例(10/17)行IVUS检查,11例(11/17)行OCT检查,其中4例同时行IVUS和OCT检查。IVUS和OCT均能清晰显示撕裂的内膜片及分隔开的真腔和假腔。4例(4/17)患者接受经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI),13例(13/17)患者接受药物保守治疗。4例(4/17)患者1年后再次来院复查冠状动脉造影及IVUS,其中2例接受PCI的患者支架通畅,IVUS检查示支架贴壁良好;另2例接受药物治疗的患者IVUS检查示夹层消失。所有患者在随访期间未发生任何缺血事件。结论SCAD是临床少见的一类急性冠状动脉综合征,应用IVUS和OCT有助于准确评估SCAD,进而为SCAD治疗策略的选择提供一定依据。

关键词(KeyWords)： 自发性冠状动脉夹层;血管内超声;光学相干断层成像;冠状动脉造影

Abstract:

Keywords:

基金项目(Foundation): 南京医科大学科技发展基金重点项目(2015NJMUZD051)

作者(Author): 郑亚国,许田,陈亮,单守杰,林松,张俊杰,陈绍良

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