经皮冠状动脉成形术和内支架植入术的临床应用(附48例分析)

The Clinical Application of Percutaneous Transluminal Coronary Angioplasty and Intracoronary Stenting in 48 Patients with Coronary Artery Disease

目的 探讨经皮腔内冠状动脉成形术 (PTCA)和内支架术 (CASI)治疗冠状动脉狭窄的适应症及其血运重建疗效。方法 48例经冠状动脉造影 (CAG)证实诊断的冠心病患者 ,受累血管 93支共计 12 6处狭窄 ,对其中 6 0支病变血管施行 PTCA和 CASI,单纯 PTCA8例 11支血管 ,CASI37例 49支血管 ,共植入内支架 5 6枚。另 3例术中因出现剧烈的心绞痛等并发症而改行其它方法治疗。结果 单纯 PTCA仅 4支血管狭窄程度改善 >5 0 % ,达到技术标准 ,另 7支均不足 5 0 % ;而 CASI全部获得成功 ,术后经造影证实血运重建效果满意。结论 CASI可有效预防或矫治 PTCA的并发症 ,补偿 PTCA后疗效的不满意 ,近期血液动力学的改善效果优于单纯

Objective:To study the indication of percutaneous transluminal coronary angioplasty(PTCA)and intracoronary stenting(CASI) on revascularization of stenosed vessel in patients with coronary artery disease and evaluate their effect.Methods:126 stenoses of 93 branches diseased vessels were ascertained by angiogram in 48 patients with coronary atherosclerotic cardiopathy(CAD),of which 60 branches of stenosed vessels underwent both PTCA and CASI,the size of stent implanted intracoronary artery was selected according to the diameter of the diseased vessel lumen in angiogram at the ratio 1∶1.Results:Recanalization of stenosed vessels were improved by 43% in 11 branches of 8 patients by PTCA alone,of which only 4 branches diseased vessels lumen were increased more than 50% and up to technical standard.CASI was successfully performed in 37 cases with 49 branches of coronary arterial lesions,using a total of 56 stents,and by immediate angiography after the procedure,It showed that recanalizations were successful in all the 37 cases.But in 3 cases complications such as angina pectoris occurred and another treatment was performed.Conclusion:Benefited from its supporting action,intracoronary stenting has the advantage of reducing incidence of early restenosis and complications which often occurred in primary PTCA,such as acute occlusion and/or dissecting aneurysm of artery caused by intima injury,acute coronary arterial spasm,vascular retraction.The procedure of CASI for treating CAD is obviously superior to PTCA alone on the improving effect of hemodynamics in short term.