何东方,郭成军,李果,赵林,迟云鹏,方冬平,卢春山,刘梅颜,郝篷,张英川

• 1:首都医科大学附属北京安贞医院心内6科

摘要(Abstract)：

目的回顾分析冠状动脉自发性夹层(SCAD)患者的临床资料,探讨治疗策略。方法回顾分析2010年7月至2013年3月单中心冠状动脉造影患者4517例,检出SCAD 13例,借用冠状动脉夹层分型系统对病变进行分类,分析不同类型SCAD的发生率、影像特点及随访临床事件。结果13例SCAD患者中,2例(2/13,15.4%)发生2处夹层,共存在15处夹层。12例(92.3%)发生临床事件,包括心肌梗死10例(76.9%)与心绞痛2例(15.4%)。发生于右冠状动脉夹层9处(9/15,60%),前降支6处(6/15,40%),左回旋支未见夹层。A型病变1处(6.7%),B型2处(13.3%),D型8处(53.3%),E型2处(13.3%),F型1处(6.7%),壁间血肿1处(6.7%)。4例5处保守治疗,9例10处病变给予经皮冠状动脉介入治疗(PCI),9处病变PCI治疗成功,1处未成功改为冠状动脉旁路移植术。1例D型夹层患者药物治疗6个月后复查冠状动脉造影,夹层无明显变化,无心绞痛发作;1例D型夹层患者药物治疗3个月,仍有心绞痛,给予PCI治疗;1例A型夹层患者PCI后12个月复查冠状动脉造影未见夹层复发,无再狭窄。其余患者电话随访6~12个月无临床事件。结论SCAD可以按照NHLBI分型。A、B、E型及壁间血肿采取PCI治疗相对容易。D型夹层占比例最高。D、F型治疗难度最大。关键在于早期确诊。可以根据病变的类型、长度,选择性地采取PCI治疗,保守治疗是否可以自愈仍需长期随访。

关键词(KeyWords)： 冠状动脉自发性夹层;介入治疗;血管内超声

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 何东方,郭成军,李果,赵林,迟云鹏,方冬平,卢春山,刘梅颜,郝篷,张英川

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