摘要
目的总结冠状动脉支架内慢性完全闭塞(in-stent chronic total occlusion,ISCTO)病变应用经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)的技术及长期疗效。方法回顾性分析ISCTO135例的临床、介入手术资料及术后长期随访结果,总结PCI治疗技术及经验。结果PCI病变成功率93.2%(136/146),病例成功率94.1%(127/135)。单纯经皮腔内球囊血管成形术(percutaneous transcoronary angioplasty,PTCA)23例(17.0%),再次置入支架112例(83.0%)。置入的112枚支架中药物洗脱支架94枚(83.9%)。具有支架内闭塞时间超过6个月、绝对性闭塞、闭塞部位呈刀切状、有分支发出、闭塞长度在15mm或以上、病变近端或病变处弯曲在45°或以上特征的ISCTO病变较不具备这些特征的病变PCI成功率降低(88.2%与97.4%,89.7%与98.3%,81.8%与98.0%,82.9%与97.1%,87.8%与98.6%,86.2%与97.7%,P<0.05)。8例患者10处病变PCI操作失败,其中导丝不能通过ISCTO病变7处,球囊不能跨越病变2处,开通血管后发生无复流1处。术中发生心室颤动1例,急性左心衰竭1例,均处理成功。术后住院期间无主要不良心脏事件发生,心绞痛症状缓解率为89.0%。临床随访4～78个月,造影随访72例(53.3%),发现心绞痛复发23例(17%),靶血管重建16例(11.9%),心脏性猝死4例(3.0%)。结论ISCTO成功PCI因素包括合适的手术时机、适当的手术器械选择及术者的经验及决策。手术难度虽大,但一旦成功,患者将明显受益。
Objectives To assess the technique and long-term outcomes of percutaneous coronary intervention treatment for patients with in-stent chronic total occlusion （ISCTO）. Methodss We retrospectively analyzed the clinical data, characteristic of lesions and outcomes of PCI from 135 patients with ISCTO who were detected by coronary angiography. The occlusion duration was from 3 months to 72 months （12±10） months. A total of 146 ISCTO lesions were treated interventionally. Results Total success rates of lesions and patients were 93.2% （136/146） and 94.1% （127/135）, respectively. Among the 146 lesions with ISCTO, 23 （17.0%） of them were treated with percutaneous transcoronary angioplasty （PTCA） and 112 （83.0%） with re-stent implantation. There were 94 （83.9%） drug-eluting stents among the 112 stents re-implanted. The success rates of PCI decreased when in-stent occlusion was characterized with long occlusion time, absolute occlusion, stump missing or bifurcation in ISCTO, ≥ 15mm in length and ≥45° tortuosity of proximal segment （88.2% vs 97.4%, 89.7% vs 98.3%, 81.8% vs 98.0%, 82.9% vs 97.1%, 87.8% vs 98.6%, 86.2% vs 97.7%,P〈0.05）. Operative failures were occurred in 10 lesions of 8 patients. Guide wire and balloon failed to pass through the occlusion accounted for 7 cases and 2 cases respectively, 1 cases failed due to no reflow after recanalization. One patient suffered from ventricular fibrillation and another from acute left heart failure during operation, both were treated successfully. No major adverse coronary events （MACE） occured after operation in hospital. The angina-free survival rate were 89% at discharge. During the 4-78 months follow-up, among which 72 angiographic follow-up were performed, angina and recanalization recurred in 23 （17.0%） cases and 16 （11.9%） cases respectively, cardiac death developed in 4 cases. Conclusions The successful outcomes of PCI in patients with ISCTO lesions are due to the optimal operation opportunity, the adequate intervention instruments and the experience and decision of the operator. In spite of difficulties of the operation, patients will benefit greatly once it succeed.
出处
《岭南心血管病杂志》
2008年第1期15-19,共5页
South China Journal of Cardiovascular Diseases
关键词
冠状动脉疾病
慢性完全闭塞
支架
再狭窄
血管成形术
经腔
经皮冠状动脉
coronary heart disease
chronic total occlusion
stent
restenosis
angioplasty, transluminal,percutaneous coronary
