冠状动脉瘤的临床特征及治疗

Clinical features and treatment of coronary artery aneurysms

目的探讨冠状动脉瘤的临床特征及治疗方案。方法对32例在南方医科大学深圳医院和深圳市人民医院经冠状动脉造影证实为冠状动脉瘤样扩张的患者,分析其临床资料及冠状动脉造影图像特征,并对接受不同治疗方案的患者进行随访。结果1778例行冠状动脉造影术的患者中,发现冠状动脉瘤32例,检出率为1.8%(32/1778)。瘤样扩张好发部位依次为右冠状动脉、左前降支、回旋支,左主干罕见。冠状动脉瘤合并冠状动脉狭窄>50%的患者25例。32例患者均给予抗凝、抗血小板、解痉及他汀类药物治疗,其中2例行支架植入术,6例行冠状动脉旁路移植术及瘤体结扎。平均随访15个月,有1例在随访期间再发急性心肌梗死,冠状动脉造影见瘤样扩张后狭窄的血管段发生栓塞致血管闭塞,余所有患者随访过程中未发生心绞痛、急性心肌梗死和心源性猝死等主要心血管事件。结论临床上冠状动脉瘤并不少见。冠状动脉内血栓栓塞、血栓形成及血管痉挛是临床上发生心绞痛、心肌梗死的主要原因。抗凝、抗血小板聚集、解痉等药物治疗和/或恰当的冠状动脉旁路移植可明显改善冠状动脉瘤患者的临床预后。

Objective To investigate the clinical characteristics and therapeutic methods of coronary artery aneurysm(CAA).Methods The clinical data and coronary angiography of 32 patients confirmed by coronary angiography as coronary aneurysm in Shenzhen Hospital of Southern Medical University and Shenzhen People′s Hospital were collected.They were followed up,and the different therapeutic methods were analyzed.Results Thirty-two cases(1.8%)of coronary artery aneurysms were found in 1778 patients undergoing coronary angiography.The main sites of coronary ectasia were right coronary artery,anterior descending branch and circumflex branch,and the left main branch was rare.Among the patients with coronary artery aneurysms,there were 25 patients with coronary artery stenosis.All the 32 patients were given anticoagulant,antiplatelet,improvement of coronary spasm and statin therapy,among whom 2 patients were treated with stent implantation and 6 patients were treated with coronary artery bypass graft(CABG)and ligation of coronary aneurysm.During the follow-up(average 15 months)of 1 patient,acute myocardial infarction reoccurred,and coronary angiography indicated that the stenosed coronary segments after artery ectasia was occluded because of thromboembolism.In the remaining patients,there were no major cardiovascular events such as angina pectoris,acute myocardial infarction and sudden cardiac death.Conclusions Coronary artery aneurysm is not a rare heart disease.Coronary thromboembolism,thrombosis and vasospasm are the main causes of angina pectoris and myocardial infarction.Anticoagulant,antiplatelet,antispasmodic drugs and suitable coronary artery bypass can significantly improve the clinical prognosis of patients with coronary artery aneurysm.