冠状动脉和肾动脉狭窄同期介入治疗的安全性和急性期疗效

Simultaneous endovascular therapy of coronary and renal artery narrowing:safety and acute efficacy

目的回顾性分析冠状动脉狭窄和肾动脉狭窄患者同一住院期间内行经皮介入治疗的安全性和急性期疗效。方法血管造影检查证实的冠状动脉狭窄合并肾动脉狭窄患者,根据造影剂用量和术前肾功能情况,于冠状动脉介入治疗后即刻、7 d内和7 d后行肾动脉介入治疗。结果102例患者共有148处冠状动脉狭窄和113处肾动脉病变植入支架,即刻手术均成功。术后30 d随访,1例患者于术后15 d因自行停止服用氯吡格雷后出现心肌梗死,其余患者无不良心脏事件发生。65例高血压患者中,7例(10.7%)血压恢复正常,11例(16.9%)抗高血压药物减量,其余47例(72.3%)患者的血压无变化。21例慢性肾衰竭患者术前血肌酐水平为(158±57)μmol/L,术后为(142±71)μmol/L,差异无统计学意义(P>0.05)。结论冠状动脉狭窄和肾动脉狭窄患者同一住院期间内行经皮介入治疗是安全有效的。

Objective To retrospectively analyze the safety and acute efficacy of simultaneous endovascular therapy for both coronary and renal artery narrowing. Methods Patients confirmed with both coronary and renal artery narrowing by angiography underwent renal artery stenting immediately, within 7 days or 7 days after coronary intervention while taking into consideration of the baseline renal function and contrast volume. Results The 102 patients had 148 coronary and 113 renal narrowing sites, and all successfully underwent stent- based endovascular therapy. During 30 days＇ follow-up, there were no major adverse cardiovascular events, except that one patient suffered myocardial infarction due to clopedogrel cessation. Sixty-five cases with hypertension history; the blood pressure recovered to normal level in 7 （10. 7%） cases and improved in 11 （ 16.9% ） cases; and the remaining 47 （72.3%） cases had no obvious changes. Serum creatinine levels were similar in 21 cases with renal dysfunction before and after procedures（[ 158 ± 57] μmol/L vs. [ 142 ±71] μmol/L, P〉0. 05）. Conclusion Simultaneous endovascular therapy in patients with both coronary and renal artery narrowing is safe and effective.