药物洗脱支架置入术后严重冠状动脉痉挛28例分析

Clinical analysis of severe coronary artery spsam after drug-eluting stent implation in 28 patients

目的:探讨药物洗脱支架(DES)置入术后严重冠状动脉(冠脉)痉挛的特点及预后。方法:回顾性分析2012例行冠脉药物支架置入术患者,随访1年,分析其严重冠脉痉挛的发生率、临床情况、冠脉造影和置入支架情况、痉挛发生时间、部位以及处理、预后。结果:DES置入术后1年内严重冠脉痉挛(冠脉直径狭窄≥95%)有28例(1.39%)。其中,急性冠脉综合征19例(67.8%)、多支血管病变20例(71.4%)、支架长度≤29mm25例(89.2%)。严重冠脉痉挛发生时间最常见在导管室和术后24h内,共18例(64.3%)、与术后1周内5例、术后4周内3例、术后1年内2例比较,差异均具有统计学意义(P<0.05)。严重冠脉痉挛最常发生部位为支架两端,共24例(85.7%),非靶血管严重痉挛病例4例(14.3%),差异具有统计学意义(P<0.01)。及时复查冠脉造影以及冠脉内注入血管扩张剂、必要时主动脉球囊反搏支持和支架置入是抢救的关键,一般预后较好。结论:DES置入术后严重冠脉痉挛并非罕见,其中在急性冠脉综合征、多支血管病变、支架长度≤29mm多见。严重冠脉痉挛最常发生在导管室和术后24h内的支架两端。

Objective：To investigate the clinical manifestations and prognosis of severe coronary artery spasm after drug-eluting stent implation.Method：The study enrolled 2 012 patients with drug-eluting stent implation and 1 year follow-up.Incidence,clinical setting,angiograph and stent implation setting,the time and site,treatment and prognosis of severe coronary artery spasm were analysised after drug-eluting stent implation.Result：The 28 patients （1.39%） were found having severe coronary artery spasm in one year after drug-eluting stent implation.There were 19 patients with acute coronary syndrome （67.8%）,20 with multivessel disease （71.4%） and 25 with stent length ≤29 mm （89.2%）.It is the most easily appeared within catheter department and within 24 h afteroperation.There were 18 patients （64.3%） of severe coronary artery spasm at the catheter department and whithin 24 h after drug-eluting stent implation.Stent-edge is most commonly seen with the appearance of severe coronary artery spasm contrasting to non-target vessel （24：8,P0.01）.Conclusion：Severe coronary artery spasm is no rare after drug-eluting stent implation.ACS,multivessel disease and stent length ≤29 mm are prognostic factors of severe coronary artery spasm.It most commonly appears at the stent-edge within the catheter department and whithin 24 h after drug-eluting stent implation.