经皮冠状动脉介入治疗右冠状动脉起源异常的不稳定型心绞痛

Effect of percutaneous coronary intervention in patients with unstable angina pectoris with anomalous right coronary arterial origin

目的分析右冠状动脉（fight coronary artery，RCA）起源异常的不稳定型心绞痛经皮冠状动脉介入（percutaneous coronary intervention．PCI）治疗的临床特点。方法回顾性分析2005年10月至2012年10月武汉市第五人民医院收治行PCI治疗的不稳定型心绞痛合并RCA起源异常5例患者的临床资料。结果共计623例不稳定型心绞痛患者中6例合并存在RCA起源异常，其中5例罪犯血管为RCA，发生率0．96％。5例患者中男3例，女2例．中位年龄57（32～75）岁；其中RCA起源于左冠状窦3例，起源于嵴上1例，起源于主动脉前壁1例；单支血管病变4例，两支血管病变1例；4例植入药物洗脱支架1枚，1例植入药物洗脱支架2枚；5例PCI治疗围术期无夹层、血栓、心肌梗死、心力衰竭、脑卒中、死亡等并发症发生；随访14．6（6-24）个月，无心绞痛、死亡、再次冠状动脉事件入院、再次血管化等主要心血管事件发生。结论PCI治疗为RCA起源异常的不稳定型心绞痛患者提供了一种安全有效的治疗方法。

Objectives To evaluate the clinical characteristics of percutaneous coronary intervention （PCI） for patients with unstable angina pectoris （UAP） with anomalous right coronary arterial （RCA） origin. Methods A retrospective analysis was conducted on the clinical data and follow-up of 5 cases with UAP with anomalous RCA origin in The Fifth Hospital of Wuhan from October 2005 to October 2012. Results Six out of 623 patients （incidence rate： 0.96% ） of UAP were with anomalous RCA origin, in whom ischemia-related arteries of 5 patients were RCA. For the 5 cases, the average age was 57 （ranged from 32 to 75 ） years old, and there were 3 males and 2 females. Anomalous RCA originated from left coronary sinus in 3 cases, from antetheca of the aortic wall in 1 case and from supracristal plane above the coronary sinus in 1 case. Four patients were with single vascular lesion and one case with two vascular disease; One drug- eluting stent was respectively implanted in 4 patients and two drtlg-eluting stents in 1 patient. The PCI procedures were successful in all patients. There were no dissection, thrombus, perioperative myocardial infarction, heart failure, stroke or death during the procedure period. All patients remained free from major adverse cardiovascular events and target vascular revascularization during the 14.6 （ranged from 6 to 24） months＇ follow-up period. Conclusions PCI provides a feasible and secure approach for patients with UAP with anomalous RCA origin.