慢性完全闭塞病变2051例的临床及影像学分析Clinical and imaging analysis of chronic total occlusion in 2051 patients
韩雅玲,张剑,荆全民,王守力,马颖艳,栾波,王耿
摘要(Abstract)：
目的总结慢性完全闭塞(CTO)冠状动脉(冠脉)病变的临床和影像学特点。方法回顾性分析1989年6月至2005年5月诊断冠心病并经冠脉造影证实有CTO病变患者的临床和冠脉造影资料。结果有一支以上CTO病变者共2051例,涉及2848支CTO血管;年龄25~86(60.5±10.5)岁;男1051例(占80.5%)。其中临床不稳定型心绞痛1027例(占50.1%),有心肌梗死史878例(占42.8%);吸烟者900例(占43.9%),合并高血压病1142例(占55.7%),糖尿病451例(占22.0%),高脂血症394例(占19.2%)。病变血管包括有桥状侧支循环形成的CTO血管985支(占34.6%),CTO闭塞段呈刀切状为909支(占31.9%);≥15mm的CTO病变1632支(占57.3%);病变近端或病变处弯曲≥45度有1124支(占39.5%),病变近端或病变处钙化501支(占17.6%);闭塞处有分支发出的CTO血管834支(占29.3%);CTO位于血管开口处为1149支(占47.1%),位于血管远端1341支(占24.1%)。结论本组CTO病例有吸烟、高血压、糖尿病及高脂血症等冠心病危险因素的比例较高;患有不稳定型心绞痛、陈旧性心肌梗死、心力衰竭、心律失常、脑血管病的比例亦较高;病变血管具有桥侧支、刀切状CTO断端、闭塞长度≥15mm、病变近端或病变处弯曲≥45度,较多患者影像上存在中重度钙化、闭塞处有分支发出及CTO位于血管开口处等特征。这些临床及影像学特征可能增加CTO病变行PCI治疗的难度,对成功率有一定影响。糖尿病、高血压病、吸烟、心功能、病程对CTO病变影像学特征有一定影响。
关键词(KeyWords)： 冠状动脉疾病;血管成形术,经腔,经皮冠状动脉
基金项目(Foundation): 中国人民解放军“九五”攻关面上课题(A96M002)
作者(Author): 韩雅玲,张剑,荆全民,王守力,马颖艳,栾波,王耿
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