可疑编织样冠状动脉6例临床及影像学分析

Clinical and imaging analysis of 6 cases of suspected woven coronary artery and literature review

目的分析可疑编织样冠状动脉患者的临床及影像学特点,探讨其治疗与预后。方法纳入6例冠状动脉造影检查发现冠状动脉呈现“编织样”或“蜂窝样”充盈缺损的患者,经光学相干断层成像(OCT)明确诊断为编织样冠状动脉3例、血栓再通3例。分析患者的临床特征、影像学资料、治疗方案,并随访观察其主要不良心脑血管事件(MACCE)发生情况以评估预后。结果编织样冠状动脉在OCT中显示为多个互不相通的小血管,血管结构完整。编织样冠状动脉患者中2例患者发生急性心肌梗死行介入治疗,1例患者为陈旧性心肌梗死伴心绞痛,接受单纯药物治疗;随访期间(中位随访时间20.5个月)均未发生MACCE。血栓再通OCT表现为多个微通道相互连通,血管壁结构不完整。血栓再通3例患者均有显著的心肌缺血症状,具备经皮冠状动脉介入治疗(PCI)适应证,均接受PCI;随访期间(中位随访时间20.5个月)有1例患者发生MACCE。结论编织样冠状动脉在结合临床表现、有效评估心肌缺血及病变程度选择合理的治疗方案后,一般可以获得较好的预后。对血栓再通患者,需根据心肌缺血证据和远端血管功能评价选择适当的治疗策略,并进行积极随访有助于预防MACCE发生。

Objective To analyze the clinical and imaging features of patients with suspected woven coronary artery,and to explore the therapy strategy and long-term prognosis.Methods Optical coherence tomography(OCT)was performed in six patients with braided-like or honeycomb-like filling defects in coronary after coronary angiography(CAG).Through the implementation of OCT,three of the six patients were confirmed as woven coronary artery and the other three patients were diagnosed as thrombus recanalization.The clinical materials,imaging and treatment from these patients were analyzed,and the major adverse cardiovascular and cerebrovascular events(MACCE)were followed up to evaluate the prognosis.Results Woven coronary artery showed multiple unconnected small vessels in OCT,and the vascular structure was complete.Two of these patients had acute myocardial infarction and received interventional therapy,and one patient was prior myocardial infarction with angina pectoris,only drug treatment was used.No MACCE occurred during the follow-up period(median 20.5 months).While thrombus recanalization showed that multiple microchannels were connected and the wall structure was incomplete under OCT.All these patients were treated with PCI for symptoms of myocardial ischemia with indication.During the follow-up period(median 20.5 months),one patient developed MACCE.Conclusions Patients with woven coronary artery may have better prognosis after evaluating myocardial ischemia eff ectively and selecting reasonable treatment according to clinical manifestations and pathological degree.In patients with thrombus recanalization,appropriate treatment strategies should be selected according to the evidence of myocardial ischemia and distal vascular function evaluation,and active follow-up is helpful to prevent the occurrence of MACCE.