经皮腔内冠状动脉成形术的急性血管并发症及处理

The acute vascular complications and treatment in percutaneous transluminal coronary angioplasty

我科自１９８７年１２月至１９９４年４月间完成经皮腔内冠状动脉成形术（ＰＴＣＡ）４３０例，共扩张血管７０７支，扩张病变７６４处，成功率分别为９５．１％，９６．９％和９７．１％。其中多支血管行ＰＴＣＡ共２０９例，失败共２１例（４．９％）。发生急性血管并发症４０处（５．２％），其中严重内膜撕裂１７处（２．２％），冠脉痉挛和血栓形成各６处（０．８％），急性闭塞１７处（２．２％），血管穿孔１处（０．１％），边支闭塞５处（０．７％）。术终处理成功率为９７．５％，最终处理成功率为８２．５％，未出现需紧急冠状动脉旁路术者。并发症较易出现在不稳定性心绞痛、多支血管病变、一次扩张多处病变者；Ｂ、Ｃ型复杂病变的ＰＴＣＡ，尤以严重偏心病变、长节段管状病变及弥漫病变、严重钙化、成角＞４５°的病变。我们的经验认为：低压力、长时间的重新扩张是处理并发症的最有效措施之一。

Abstract From December 1987 to April 1994, 430 cases of percutaneous transluminal coronary angioplasty (PTCA) were performed in patients with 707 diseased vessels and 764 lesions. The success rate was 95.2% in 430 patients, 96. 89% in 707 diseased vessels and 97.12% in 764 lesions.PTCA was failed in 21 cases.Among these 764 lesions dilated, there were 40 (5.24 %) acute vascular complications. Among which,acute vascular occlusions in 17 (2.23%), dissection of vascular intima in 17 (2.23%),occlusion of one of the coronary branches in 5 (0.65%) and thrombosis in 6 (0.79%),vascular spasm in 6 (0. 79%), vascular perforation in 1 (0.13%).The success rate of treating complications were 97. 5% after PTCA and 82. 5% by the end.The results showed that unstable angina, multiple vessels disease, dilating multiple lesions at one time,morphological characteristics of lesions and vessels are very important risks for the acute vascular complications.One of the effective methods to treat the vascular complications is to redilate the lesion with lower pressure sand longer time.