经皮腔内冠状动脉成形术在冠心病治疗中的应用

Application of PTCA for patients with coronary artery disease

我们自1987年至1995年对146例冠心病病人行了经皮冠状动脉成形术治疗,共扩张病变339处,病变扩张成功率95.6%,其中达完全性心血运重建58例(39.7%).这部分血运重建82例(56.2%),病例扩张成功率95.9%,术中死亡1例,术后24小时死亡2例,死亡率2.1%. 扩张时22处病变出现严重内膜撕裂而需植入血管支架.8例病变分别行了旋磨和旋切治疗,术后随访16.2(1～96)个月,84%病例心绞痛完全消失,2例分别死于心衰和再梗.7/20例术后3个月至6年行造影示再狭窄.

From April 1987 to December 1995,146 patients (Pts) with coronary artery disease (CAD) underwent PTCA. There were 133 male & 13 female with a mean age of 58 (33-76) yrs. The total lesions were 425 including 34 (8.0%) lesions in type A,214 (50. 4%) in type B &. 91 (41. 6%) in type C. The PTCA target lesions were 339 with 37 (8. 7%) total occlusion lesions. Twenty-two lesions had severe dissection following balloon dilatation & successful coronary stenting were done immediately. Another 40 stents were implanted for de novo severe proximal vessel lesions. Five Pts underwent rotational ablation & 3 underwent direct coronary atherectomy. Success dilatation was 95. 9% of total Pts & 95. 6 % of total lesions. The average stenosis in diameter reduced from 89. 1% to 9.8% (P<0. 0001). One Pt with 3-vessel disease & very poor left ventricular function die during the procedure & 2 die 24 hrs following PTCA. Hematoma was noted in 2 Pts. No AMI occurred & no acute CABG needed.During a 1-96 (average 16. 2) months follow-up period,84. 0% of Pts had no angina. Twenty Pts with recurrent chest pain repeat angiography showed 7 restenosis. Thus, PTCA is an effective method & relative saft for Pts with CAD.