10例冠状动脉穿孔患者置入带膜支架后的长期随访研究Long-term follow-up study of patients with covered stent implantation after coronary perforation
王耿,韩雅玲,荆全民,王效增,马颖艳,王斌
摘要(Abstract)：
目的评价带膜支架治疗经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)术中发生冠状动脉穿孔患者的长期疗效。方法从2004年6月至2012年6月,本中心共对10例PCI中发生冠状动脉穿孔后置入带膜支架的患者进行了随访,观察其主要心脏不良事件(major adverse cardiac events,MACE)发生率。置入带膜支架术后服用氯吡格雷75mg/d共2年,长期服用肠溶阿司匹林100mg/d。结果 10例患者中男性6例,女性4例;年龄(68.6±5.2)岁,范围60～76岁。置入带膜支架直径平均(3.3±0.3)mm,长度平均(22.1±3.7)mm,所有患者破口均被成功封闭,术中无死亡病例。随访时间(31.7±24.5)个月,范围0.6～67个月,1例术后19天因肺部感染导致多器官功能衰竭而死亡,1例术后13个月猝死;1例患者术后53个月出现心绞痛;1例术后6个月查多层CT示支架内无再狭窄;4例患者复查冠状动脉造影,只有1例患者在PCI术后67个月复查冠状动脉造影示左前降支(LAD)带膜支架内再狭窄;另3例病例带膜支架内均无再狭窄。住院期间死亡率为10%(1/10);PCI术后12个月,MACE发生率为10%(1/10);在整个随访期间靶血管再狭窄率为20%(1/5),死亡率为20%(2/10),MACE发生率为40%(4/10)。结论带膜支架治疗冠状动脉穿孔能达到较好的长期疗效,两年的双联抗血小板药物可能能有效预防带膜支架内血栓形成。
关键词(KeyWords)： 冠状动脉穿孔;血管成形术,经腔,经皮冠状动脉;支架
基金项目(Foundation): 全军首批临床高新技术重大项目课题([2002]卫医字第18号)
作者(Author): 王耿,韩雅玲,荆全民,王效增,马颖艳,王斌
参考文献(References)：
- [1]Ellis SG,Ajluni S,Arnold AZ,et al.Increased coronary perforation in the new device era.Incidence,classification,management,and outcome.Circulation,1994,90:2725-2730.
- [2]Al-Lamee R,Ielasi A,Latib A,et al.Incidence,predictors,management,immediate and long-term outcomes following gradeⅢcoronary perforation.Cardio Interv,2011,4:87-95.
- [3]韩雅玲,梁延春,孙鸣宇,等.心脏介入性治疗早发和迟发心脏压塞的诊断与处理.中国心律失常学杂志,2003,7:283-286.
- [4]Fasseas P,Orford JL,Panetta CJ,et al.Incidence,correlates,management,and clinical outcome of coronary perforation:analysis of16298procedures.Am Heart J,2004,147:140-145.
- [5]Javaid A,Buch AN,Satler LF,et al.Management and outcomes of coronary artery perforation during percutaneous coronary intervention.Am J Cardiol,2006,98:911-914.
- [6]Lansky AJ,Yang YM,KhanY,et al.Treatment of coronary artery perforations complicating percutaneous coronary intervention with a polytetrafluoroethylene-covered stent graft.Am Heart J,2006,98:370-374.
- [7]Albiero R,Silber S,Di Mario C,et al.Cutting balloon versus conventional balloon angioplasty for the treatment of in-stent restenosis.Results of the restenosis cutting balloon evaluation trial(RESCUT).J Am Coll Cardiol,2004,43:943-949.