冠状动脉痉挛的血管造影表现(附37例报告)

The angiographic findings of coronary arterial spasm (A report of 37 cases)

目的冠脉造影中的痉挛为病理自发性及导管造影刺激引起,使狭窄病变危险增加,须以重视及予以处理。方法本组按Judkins法行选择性冠状动脉造影中出现37例痉孪,男23女14,年龄43至60岁(平均47岁),自发性心绞痛15例。痉挛经硝酸甘油冠脉内注射处理后均缓解。结果单发痉挛多见,表现为(1)左冠脉前降支近中段12例,右冠脉近中段5例,均在10mm以上,呈“长桥”状改变,缩窄达50%～65%,累及分支开口;(2)右冠脉开口鸟咀样缩窄3例;(3)左前降支及回旋支不规则轻度局限偏心型各4例。(4)右冠脉多发痉挛5例,左前降支4例。合并狭窄者19例,痉挛与粥样硬化部位对应。结论由导管造影刺激引起的痉挛无胸闷和心电图改变。自发痉挛的年龄段与冠心病高发增长期相符,提示为心梗前期病变可能;影像学特征有助于鉴别。

Objective The arterial spasm which often seen in the coronary angiography was considered as a result of the pathological spasm of the coronary artery or a complication of catheterization. The coronary arterial spasm is a considerable situation because it increases the danger of stenotic lesions in coronary artery, which should be managed immediately. Methods In total 37 patients presented with coronary arterial spasm in the coronary angiography(Judkins method):23 male and 14 female, aged 43-60years (the 47 years inaverage). Spasms were relieved in all patients after the administration of glonoin. Results Solitary spasm were the most common, the angiographic findings were long section( >10mm) with stenosis of 50%-65%in left anterior descending artery (12 cases), or in the middle and near portion of the right coronary artery (5 cases), where the orifice of the branches were involved; severe stenosis of the orifice of the right coronary artery (3 cases); irregular, mild and local spasm in left anterior descending artery or circunflex (8 cases). And mutiple spasm was observed in left anterior descending artery(4 cases) or in the right coronary artery (5 cases). In 19 cases, stenosis accompanying with spasm were revealed and local spasm were oberved at the site of arterial sclerosis. Conclusion The spasm owing to the catheterization doesn't result in chest discomfort and changes in EKG, while pathological spasm occurres in the population with high risk of coronary heart disease,which indicates the potential myocardial infraction. The angiographic findings helps differentiating the two situation.