不稳定心绞痛经皮腔内冠状动脉成形术190例分析

PERCUTANOUS TRANSLUMINAL CORONARY ANGIOPLASTY FOR UNSTABLE ANGINA

１９８７年１２月至１９９４年２月该院共完成不稳定心绞痛的经皮腔内冠状动脉成形术（ＰＴＣＡ）１９０例，其中有单支血管病６９例（３６．３％）、双支血管病６７例（３５．２％）、三支血管病５４例（２８．４％）。ＰＴＣＡ共扩张血管２５０支，扩张病变２７８处。Ａ型病变５２处（１８．７％），Ｂ型病变１７５处（６２．９％）、Ｃ型病变５１处（１８．４％）。在１２１例多支血管病中，２３例（１９．０％）为完全血管再通，９８例（８１．０％）为不完全血管再通。６例采用双球囊对吻技术，５例采用灌注球囊导管，４例进行了冠脉内膜定向切除术（ＤＣＡ），４例放置冠状动脉内膜支架。ＰＴＣＡ的病例成功率为９４．７％（１８０／１９０），血管成功率９５．２％（２３８／２５０），病变成功率９５．５％（２６６／２７８），由ＰＴＣＡ术前平均狭窄８８．７％±８．３％至扩张后残余狭窄１７．９％±９．２％。发生严重并发症１８处（６．５％），其中１５处经处理成功，２例发生急性心肌梗塞，１例死亡，无紧急冠状动脉搭桥者。

ercutanous transluminal coronary angioplasty ( PTCA)was performed in 190 patients with 250 di-seased vessels and 278 lesions from Dec. 1987 to Feb. 1994.All the patients had unstable angina (UA).There were 52(18.7%)type A lesions,175 (62.9%)type B lesions and 51 (18.3%)type C lesions. Of the 190 patients undergoing PTCA, 134(70.5%)patients had dilatation of a single vessel,46(24.2%)of two vessels and 10(5.3%)of three or more vessels. In 121 patients with multivessel disease, 98(81.0%)had incomplete revascularization of the ischemia-related vessel(the culprit vessel)and only 23( 19.0%)had complete vessel revascularization. Kissing ballcon technique was used in six patients and autoperfusion balloon in five. There were four patients undergoing directional coronary atherectomy(DCA) and four in-tracoronary stent. The clinical (patient)success rate was 94.7%( 180/190)and technical(vessel) success rate 95.2%(238/250).The average degree of vessel stenosis was 88.7%±8.3% before PTCA and the residual tenosis was 17.9%±9.2% after PTCA. Acute vascular complications occurred in 18(6.5%)le-sions. 15 were managed successfully, two developed Q wave myocardial infarct and one died.None needed emergency coronary bypass operation. PTCA was not successful in 10 patients. In 180 patients with suc-cessful PTCA,165(91.7%)were free from UA, 15(8. 3%)patients had symptoms improved and oxygen need reduced. During a six-month follow-up, 26 patients had chest pain again with confirmed restenosis,repeated PTCA was performed successfully.