右冠状动脉慢性完全闭塞病变特点及介入治疗

Characteristics and interventional therapy of chronic total occlusion in right coronary artery

目的总结右冠状动脉慢性完全闭塞(chronic coronary artery total occlusion,CTO)病变的解剖影像特点,并分析其介入治疗方案。方法对2016年1月至2017年6月在江门市中心医院实施经皮冠状动脉介入(percutaneous coronary intervention,PCI)治疗的90例右冠状动脉CTO患者的影像及PCI治疗结果进行回顾性分析。结果右冠状动脉CTO闭塞部位在近、中、远端的分别为47例(52.2%)、28例(31.1%)、15例(16.6%)。闭塞段跨越第一、第二转弯的例数分别是53例和25例,占总例数的86.7%;闭塞处发出分支血管的有62例(68.8%);闭塞近端如刀切样的有51例(56.6%);CTO长度>15 mm的为84例(93.3%),钙化影严重的为16例(17.8%)。一共完成血运重建的为66例,成功率为73.3%。出现严重并发症主要为血管穿孔2例(2.2%),经介入方法处理后均无需外科治疗。结论右冠状动脉特殊的解剖影像增加介入治疗的难度。充分研究右冠状动脉的解剖特点有利于提高PCI治疗的成功率。

Objectives To summarize the imaging features of coronary artery lesions in patients with chronic totalocclusion（CTO） in right coronary artery and analyze the interventional treatment for them. Methods The data（imaging features of coronary artery lesions and interventional treatment） from 90 patients received percutaneouscoronary intervention（PCI）between January 2016 and June 2017 were retrospectively analyzed. Results The cases ofproximal,middle and distal segments of CTO in right coronary artery were 47（52.2%）,28（31.1%）and 15（16.6%）.86.7% cases were in the turning point;68.8% were with bridge collateral perfusion;56.6% were abrupt occlusion93.3% were with occlusion more than 15 mm,in which 17.8% showed moderator to heavy calcification. 73.3% patientscompleted revascularization. The main complications were vascular perforation in 2 cases（2.2%）,and no surgicalintervention was needed after interventional treatment. Conclusions The special angiographic characteristics maymake PCI of CTO in right coronary artery difficult. Studing the anatomic characteristics of the right coronary artery ishelpful to improve the success rate of intervention.