左主干合并右冠状动脉慢性阻塞性病变行PCI的有效性和安全性分析

The Efficiency and Safety of Percutaneous Coronary Intervention for Left Main Disease Combined with Right Coronary Artery Chronic Total Occlusion

观察左主干病变合并右冠状动脉慢性完全闭塞(CTO)的患者行个体化经皮冠状动脉介入治疗(PCI)的有效性和安全性。回顾性分析2009年1月~2014年8月,沈阳军区总医院心内科因左主干病变合并右冠状CTO病变行PCI术的患者。共入选46例患者,每位患者平均置入支架数(2.3±1.3)个,支架平均长度(29.52±6.98)mm,支架平均直径(3.61±0.42)mm。其中左主干病变行介入治疗手术成功率100%,右冠状动脉CTO病变行介入治疗手术成功率93.5%,总成功率95.7%,手术过程中无严重并发症,住院期间无急性血栓形成、无急诊冠状动脉旁路移植术(CABG)。术后心功能(左室内径、左室射血分数)较前均有改善。随访期间[平均随访时间:(14.48±15.01)个月],发生7例靶血管血运重建(其中2例CABG),主要不良心脏事件发生率15.2%。左主干病变合并右冠状动脉CTO病变采用个体化策略的冠脉介入治疗,可改善患者临床症状,同时无严重并发症发生。这提示对于左主干病变合并右冠状动脉CTO行PCI术是安全可行的。

To investigate the efficiency and safety of percutaneous coronary intervention （PCI） for left main disease combined with right coronary artery chronic total occlusion （CTO）. This study was a retrospective study, which enrolled patients underwent percutaneous coronary intervention for left main disease combined with right coronary artery chronic total occlusion between January 2009 and August 2014. A total of 46 patients were enrolled. The mean number of stent used per patients was 2.3 ± 1.3, the mean length of stents per patient was （29.52±6.98）mm and the mean stent diameter was （3.61±0.42）mm. The success rate of PCI for left main disease was 100%, while the success rate for right coronary artery CTO was 93. 5%, the total success rate was 95. 7%. There was no severe complication happened during the procedure, and no acute stent thrombosis or acute coronary artery bypass grafting. After the procedure, the cardiac function was improved. During the follow-up period （14. 48±15.01） months, there were 7 target vascular reconstruction （TVR）, among which 2 were CABG, the incidence of MACE was 15.2%. PC/for left main disease combined with right coronary artery CTO can improve the symptoms of patients, with no severe complication happened. Those results suggested that PCI was feasible for patients with left main disease combined with right coronary artery CTO.