冠状动脉无保护左主干病变支架术疗效及随访

Immediate and mid-term outcomes of stenting on unprotected left main coronary artery disease

目的评价冠状动脉无保护左主干(ULMCA)病变选择性支架术的即刻及中期疗效。方法共选择26例ULMCA病变患者,心功能均正常(射血分数>50%);合并尿毒症1例,糖尿病7例;常规行冠状动脉造影(CAG)及支架置入。分析其临床、X线影像学特征、手术成功率及6、12个月随访结果。结果CAG示孤立开口部病变6例,孤立性左主干体部病变(LMCA)8例,累及前降支及回旋支开口部病变4例,合并前降支病变2例,合并多支病变6例。支架术均获成功,术后1个月合并尿毒症患者因多脏器衰竭、心跳骤停死亡;(12±10)个月8例患者心绞痛复发;20例CAG复查4例示再狭窄,余均无症状生存。结论ULMCA支架术治疗应严格选择病例,射血分数>50%、孤立性LMCA、合并多支病变但能达到完全血运重建或存在外科手术禁忌证者可行支架术,且安全有效。

Objective To evaluate the immediate and mid-term results of unprotected left main coronary artery stenting. Methods Twenty-six patients with unprotected left main coronary disease had been treated with stents. All of them had normal left ventricular {unction （EF〉50%）, 1 case had renal failure,7 cases had diabetes mellitus. Clinical characteristics, angiographic results, success rate, severe complications and the results of followup were analyzed respectively. Results The success rate of the procedure was 100%. Six cases located in ostial,8 cases in midshaft,4 cases with distal disease, 2 cases combined with left anterior decending, 6 cases combined with mutivessel lesions. The patients were followedup for 12d： 10 months. Death developed in 1 case,angina recurrent in 8 cases. Conclusion Stenting for selected patients with unprotected left main coronary artery stenosis is feasible and safe. Unprotected LMCA stenting should be performed in patients with LVEF〉50% and isolated LMCA disease or LMCA combined with multivessel diseases in whom complete revascularization could be obtained or inoperable patients.