右冠状动脉成形术306例临床分析

An clinical analysis of angioplasty and stenting for patients with right coronary artery lesions

目的 分析评估右冠状动脉成形术（PTCA）和支架置入术的特点。方法 总结１９９５年１月至１９９９年１２月行右冠状动脉ＰＴＣＡ和支架置入术的冠心病患者３０６例。结果 对３０６例右冠状动脉的３３８处病变行ＰＴＣＡ和支架置入术；１７例失败，手术成功率为９４．４％，支架置入成功率９８．８％。其中严重夹层撕裂７例（包括２例急性心肌梗死和１例死亡），因开口异常被迫中止手术１例，导丝不能通过闭塞病变９例，心包积血死亡１例，并发急性血栓形成２例，支架远端再撕裂２例。结论 右冠状动脉因其开口位置和方向变异相对较大，走向和分支等解剖具有不同的特点，行ＰＴＣＡ和支架置入时必需考虑其特点，尽量减少并发症的发生。

Objective To analysis the reasons of failures of percutaneous transluminal coronary angioplasty (PTCA) and stenting for patients with right coronary artery lesions (RCA). Methods Three hundred six consecutive patients with right coronary artery lesions underwent PTCA and stenting, these acute results were reviewed. Results PTCA and stenting were successfully performed with 338 lesions in 306 right coronary artery of patients except 17 cases failed for artery dissection, the occluded lesions that wires can' t traverse, and the abnormal ostiums. The Procedure rate was 94.4%. Two patients died for hemopericardium and severe dissection; Four patient attacked by non-fatal Q-wave myocardial infarction due to severe arterial dissection in two cases and acute thrombogenesis occurring in 2 target lessions after stenting that confirmed by angiography. Conclusions The procedures of PTCA and stenting for RCA is different from the other coronary arteries for their anatomy. In order to lower the complications, some of characteristic of RCA should be considered in procedures.