经皮冠脉介入治疗术中并发冠脉穿孔原因分析

Clinical analysis of 9cases complicated with 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原因、类型及处理方法。方法回顾性分析2001年3月-2012年12月期间行PCI治疗的5896例患者中发生9例冠状动脉穿孔并发症患者的痛变特点、穿孔原因、处理方法及结果。结果冠脉穿孔发生率为0．15％。据Ellis分型：I型1例，Ⅱ型4例，Ⅲ型4例。受累血管分别为前降支4例，回旋支1例，右冠状动脉4例，其中CT0病变1例，B及C型病变8例，钙化病变8例。9例穿孔事件中与钢丝相关4例，与球囊预扩张相关2例，与球囊后扩张相关2例，与旋磨相关1例。5例并发心包填塞，其中迟发性2例，均成功行心包穿刺引流术，植入带膜支架2例，低压球囊扩张1例，2例仅行床旁心包穿刺引流，3例经密切观察无临床事件发生。无死亡及急诊外科手术病例。从冠脉穿孔并发症发生时间来看，主要集中出现在2008~2012年期间，可能与复杂病变PCI越来越多有关。结论冠状动脉穿孔是PCI少见严重并发症，与病变复杂程度，尤其是钙化病变关系密切。严密观察，及时心包穿刺及常规备用各种急救装备是抢救成功的关键。

Objective To evaluate the incidence, predictors, managements and clinical results of coronary artery perforation （CP） during percutaneous coronary intervention （PCI） of our hospital. Methods Among 5896 patients un- dergoing PCI from March 2001 to December 2012, 9 CP cases were found, and retrospective analysis clinical and lesion characteristics, causes, experiences and results was done. Results The incidence of CP was 0.15 ~. According to the El- lis classification, I type 1, II type 4, III type 4. The coronary vessels involved LAD （4）, LCx （1） and RCA （4）. All of the lesions are B or C type, and 1 chronic total occlusion （CTO） and 8 obvious calcified lesions. Of the 9 CP cases, the causes of perforations were wire （44.4 ~）, balloon pre-dilation （22.2 %）, post-dilation （22.2 ~） and rotational atheree- tomy （11.1~）. All the CP cases were survived after treatment. 5 patients complicated with pericardial tampanade inclu- ding 2 later onset cases, Pericardiocentesis were done for all of them, and coverd stent were implanted for 2 cases, pro- longed balloon dilation for 1 patient. 3 patients didn~ t need further intervention besides careful observation. The time course of CP was focus on 2008-2012, the increasing complexity of lesions should responsible for it. Conclusion CP is one of rare but severe complications of PCI, the occurrence of CP was related to the complexity of lesion, especially the severity of calcification. Careful observation, timely pericardiocentesis and routinely equipment of all necessary devices are important for the successful management of this serious complication.