弹簧圈栓塞术治疗冠状动脉穿孔2例的疗效

Report of 2 Cases Coronary Artery Perforation Treated by Coil Embolization

目的 探讨弹簧圈栓塞术治疗冠状动脉穿孔的疗效。方法 选择宝鸡第三医院收治的2例冠状动脉穿孔患者作为研究对象,病例1于前降支7段及第一对角支使用Collotte术式植入支架2枚,并行小球囊局部封堵,术后心包填塞,立即行床旁心包穿刺置管引流术,引流后显示造影剂外渗明显增多,遂使用弹簧圈栓塞术。病例2拟行支架植入术,球囊预扩张后弹性回缩明显,遂改为切割球囊扩张病变部位,造影见局部造影剂外渗,存在冠状动脉穿孔,立即行球囊局部封堵,术后提示心包积液增加,立即行床旁心包穿刺引流术,并使用弹簧圈栓塞术,并继续予以心包积液引流。结果 病例1术后造影未再发现局部造影剂外渗,观察6h心包积液无增加拔除心包引流管,次日复查心肌酶谱及肌钙蛋白轻度升高,患者无特殊不适。病例2术后造影未再发现局部造影剂外渗,床旁心包B超提示少量心包积液,观察6h心包积液无增加拔除心包引流管,次日复查心肌酶谱及肌钙蛋白轻度升高,患者无特殊不适。两组患者院外随访1月无特殊不适。结论 弹簧圈栓塞术可有效封闭冠状动脉穿孔破口,配合心包穿刺引流技术,可有效提示冠状动脉穿孔后心包填塞救治效果。

Objective To investigate curative effect of coil embolization in treatment of coronary artery perforation.Methods The paper chose 2 cases coronary artery perforation patients in our hospital as research objects,case 1 was treated with 2 Collotte stents implantation in the seventh segment of anterior descending branch and the first diagonal branch,with local block of small balloon.After pericardial tamponade,pericardiocentesis and drainage was performed immediately.After drainage,it showed that extravasation of contrast medium increased significantly,so spring coil embolization was appied.Case 2 was treated with stent implantation,elastic retraction was obvious after balloon pre expansion,so treatment was changed to lesion site cut of balloon expansion.Local contrast medium extravasation and coronary artery perforation were found on angiography.Local closure of balloon was performed immediately.After operation,it was suggested that pericardial effusion increased.Pericardial puncture drainage and coil embolization was performed immediately,and pericardial effusion drainage was continued.Results No local contrast medium extravasation was found in postoperative angiography for case 1.Pericardial drainage tube was removed if there was no increase in pericardial effusion after 6 hours.Myocardial enzyme spectrum and troponin increased slightly the next day,patient had no special discomfort.No local contrast medium extravasation was found in postoperative angiography for case 2,small amount of pericardial effusion was suggested by bedside pericardial B-ultrasound.Pericardial drainage tube was removed if there was no increase in pericardial effusion after 6 hours.Myocardial enzyme spectrum and troponin increased slightly the next day,patient had no special discomfort during followed up for 1 month.Conclusion Coil embolization can seal perforation of coronary artery effectively.indicate curative effect of pericardial tamponade after coronary artery perforation effectively combined with pericardial puncture and drainage technology.