冠状动脉内支架置入术治疗老年患者复杂冠状动脉病变

Coronary Stenting in Senile Patients with Complex Coronary Artery Disease

目的 探讨经皮冠状动脉腔内支架置入术治疗老年患者复杂性冠状动脉病变的疗效及安全性。方法对 4 5例冠心病患者施行冠状动脉内支架置入术 ,病变血管共 5 8支 ,B型病变 4 9处 ,C型病变 1 3处 ,慢性完全闭塞病变 4处 ,共置入支架 64只。置入左前降支 2 7只 ,左回旋支 1 3只 ,右冠状动脉 2 4只。De Novo支架置入 4 4只 ,Suboptimal支架置入 1 5只 ,Bail-out支架置入 3只 ,再狭窄病变支架置入 2只。结果 术后经冠状动脉造影证实疗效满意 ,支架置入成功率为 98.4 %。术前病变平均直径狭窄 (86.5± 7.8) % ,术后残余直径狭窄 (5 .1± 1 0 .3 ) %。住院期间无亚急性支架血栓形成。 1例出现假性动脉瘤 ,1例在术中及术后出现三次心室颤动 ,4例患者术后心绞痛复发 ,复查冠状动脉造影发现了 3个支架节段血管有再狭窄。结论 对于老年冠心病患者复杂冠状动脉病变 ,经皮冠状动脉内支架置入术是一种安全有效的介入性治疗技术 ,其成功率高 。

Objective To explore the therapeutic value and safety of coronary stenting in senile patients with complex coronary artery disease.Methods Coronary stenting was performed in 45 cases with 58 branches of coronary arterial lessions using a total of 64 stents. Forty and nine lesions were type B, 13 lesions were type C, 4 lesions were totally chronic occlusion. Twenty and seven stents were implanted in left anterior descending, 13 in left circumflex and 24 in right coronary artery. Forty and four stents were for De Novo lesions, 15 stents for suboptimal results of PTCA, 3 stents for bail out stenting and 2 stents for restenosis. Results Postoperative coronary arteriography confirmed statisfactory therapeutic effects and the success rate of the implantation was 98 4%. The mean diameter stenosis before angioplasty was 86 5±7 8%, residual stenosis following stenting was 5 1±10 3%. No other stent subacute thrombosis or severe bleeding were observed in hospital stay. One case occurred false aneurysm. Ventricular fibrillation occurred in one AMI patient during angioplasty procedure and after operation. Four cases had recurrence of angina pectoris between 3 to 6 months after stenting, and then they underwent coronary angiography and restenosis was found in 3 coronary arteries.Conclusions Percutaneous intracoronary stenting in the treatment of complex coronary artery disease is a safe and efficient interventional procedure with a high success rate and few complications