冠状动脉支架内再狭窄的特征与高压球囊治疗

Angiographic Characteristics of In-stent Restenosis and High Pressure Balloon Angioplasty

目的分析冠状动脉支架内再狭窄的特征和高压球囊扩张治疗的临床效果。方法对７例支架内再狭窄病例进行冠状动脉造影图像分析，其中６例施行高压球囊扩张治疗。结果６８例冠脉内支架术患者中，有７例经冠状动脉造影证实为支架内再狭窄，发生率为１０．２９％，出现在术后１．５～８个月。靶血管在左前降支６例，右冠状动脉１例，病变特征表现为支架内弥漫狭窄的５例，局限性狭窄２例。除１例左前降支弥漫性狭窄外，余６例用１２～１５个大气压球囊扩张术治疗。术前狭窄程度平均为８４％（７５～９８％），术后狭窄降至１２％（０～３５％），最小管腔内径从术前的平均０．５２ｍｍ增至２．６８ｍｍ。术中无严重并发症，１例在术后２个月发生再狭窄行ＣＡＢＧ术，余５例随访６个月无心肌缺血复发。结论支架内再狭窄病变可表现为弥漫性和局限性二种。高压球囊扩张术治疗支架内再狭窄是简单可行的，能获得满意的即刻造影结果和较好的远期疗效。

Objective To analyze the angiographic characteristics of in - stent restenosis and evaluate the clinical efficacy Of high pressure expandable balloon for treatment of in - stent restenosis. Methods Analyses were made on the coronary angiograms of 7 in- stent restenosis cases, 6 Of whom underwent high pressure angioplasty. Results Out of 68 cases, 7 cases were found to have in - stent restenosis (10. 29% ) which occurred between 1. 5 to 8 months after the stent implantation. The target vessels of 6 cases were in the left anterior descending arteries (LAD) and 1 case in the right coronary artery. In 5 cases, diffused stenosis was found in the stent while 2 cases had focal stenosis. Out of 7 restenosis cases, 6 underwent high pressure balloon inflation. After the balloon angioplasty, the minimal lumen diameter (MLD) of the stenostic coronary segment was increased from 0. 52 mm to 2. 68 mm and the stenostic degree was reduced from 84% (75 - 98% ) to 12 (0 - 35% ). No severe complications were revealed. During 6 months of follow - up, one case had restenosis after 2 months of balloon angioplasty and another five cases had no angina. Conclusion High pressure balloon angioplasty was a simple, safe and satisfactory treatment for in - stent restenosis.