完全闭塞性病变的冠状动脉内支架治疗

Outcome of Stent Implantation in Total Coronary Artery Occlusion

目的 :评价冠状动脉完全闭塞病变的冠状动脉内支架治疗的成功率及影响因素。方法 :对80例83支完全闭塞病变施行了经皮冠状动脉腔内成形术 (PTCA)加支架治疗。结果 :83支闭塞血管经PTCA及支架术后66支开通 ,成功率79.5%。手术成功与完全闭塞病变部位间无显著相关性。完全闭塞病变<3个月的血管再通率明显高于≥3个月闭塞病变 (P<0.01)。闭塞病变长度≤20mm的成功率 (88 7 % )显著高于闭塞长度>20mm者(63 3 % ,P<0.01)。钙化病变的成功率 (25 % )显著低于非钙化病变 (85 3 % ,P<0.01)。无桥侧支的完全闭塞病变成功率 (84 7 % )明显高于桥侧支丰富的闭塞病变成功率 (45.5 % ,P<0.01)。本组病例无1例出现严重并发症。结论 :冠脉闭塞病变的冠状动脉内支架治疗是一相对安全和有效的方法。闭塞时间、闭塞部位钙化、存在桥侧支及闭塞长度≥20mm是影响手术成功的重要因素。

Objective:To evaluate the success rate and its relative factors of stent implantation in patients with total coronary artery occlusion.Methods:Eighty patients with total occluded coronary lesions underwent percutaneous transluminal angioplasty and stent implantation.Results:Sixty_six occluded branches were revasˉcularized in80patients with83occlusions,and the success rate was79.5% (66/83).There was no significant correlation between success rate and occlusion site.The revascularized rate in occlusion within three months was higher than that in occlusion longer than three months(P<0.01).The success rate in occlusion segment shorter than20mm was significantly higher than that in occlusion segment longer than20mm(P<0.01).Non_calcification lesions had better results than calcification lesions(P<0.01).The success rate of stent in the occlusion without collateral circulation was significantly higher than that in lesion with abundant collateral cirˉculation(P<0.01).No severe complication was found in this procedure.Conclusion:The combination of PTCA and stent was a relatively safe and effective method.The occlusion time,calcification of occlusion,collateral cirˉculation,and the length of the occlusion were important factors in the treatment of total coronary artery occlusion.