李晓燕,刘金子,安永强,戚国庆,魏立业

• 1:河北医科大学第一医院冠心病中心
• 2:北京通用航天医院心血管内科

摘要(Abstract)：

冠状动脉自发夹层（SCAD）的主要病理变化是血管中层的壁内血肿，病因复杂，症状多变，可引发急性心肌梗死，且易与常规血栓性心肌梗死混淆，故漏诊及误诊率高。本病例报道1例36岁女性因搬运重物后突发胸痛，经冠状动脉造影及血管内超声确诊为左主干合并多支SCAD所致急性前壁心肌梗死。患者无传统心血管危险因素，急诊造影显示左主干、左前降支及左回旋支重度狭窄，经血管内超声明确诊断后，行急诊介入治疗，采用mini-culotte术式于左主干-左前降支、左回旋支置入药物洗脱支架。术后患者恢复良好，随访6个月无不良事件发生。本文结合文献对SCAD的病因、诊断策略及治疗选择进行探讨，强调腔内影像学在SCAD确诊中的关键作用，并指出对左主干受累等高危SCAD患者及时血运重建的重要性。

关键词(KeyWords)： 冠状动脉自发夹层;急性心肌梗死;血管内超声;经皮冠状动脉介入治疗

Abstract:

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基金项目(Foundation):

作者(Author): 李晓燕,刘金子,安永强,戚国庆,魏立业

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