经导管冠状动脉介入治疗引起冠状动脉穿孔10例临床分析

Management of coronary artery perforation during percutaneous coronary intervention

目的探讨冠状动脉介入治疗(PCI)并发冠状动脉穿孔的临床特点和处理方法。方法对我院2004～2010年10例PCI并发冠状动脉穿孔患者的穿孔原因、造影影像特点、处理方法及结果进行回顾性分析。结果穿孔血管为前降支5例、回旋支3例、右冠状动脉2例,其中C型病变5例、B型病变4例、A型病变1例。球囊扩张或支架释放压力过大致血管撕裂3例、导丝穿出血管7例;4例并发心包填塞。6例行球囊长时间低压扩张压迫、4例行心包穿刺引流。无一例死亡,无Q波性心肌梗死及急诊冠状动脉搭桥者。结论冠状动脉穿孔是PCI少见并发症、但可导致严重临床后果,及时诊断、积极处理是减少恶性心脏事件的关键。

Objective To investigate the cause and therapeutic method of coronary artery perforation during percutaneous coronary intervention（PCI）.Methods To analyze retrospectively the angiographic appearance,cause,treatment,and outcome of coronary artery perforation complicating PCI in five patients between 2004 and 2010.Results Two of the perforations were in right coronary artery,five in left anterior descending,and three in left circumflex.Five of the aim lesions were C type,Four of the aim lesions were B type,one A type.Of the ten perforations,three were caused by high-pressure inflation,seven by guide wire trauma and four by balloon oversizing;six cases complicated by pericardial tamponade.Four patients were treated by prolonged balloon inflation.There was no death,no Q-wave myocardial infarction,no emergency bypass surgery.Conclusion Coronary artery perforation is an uncommon but serious complication following PCI.Rapid diagnolosis and active treatment are key points to reduce fatal cardiac events.