摘要
目的 :评价冠状动脉 (冠脉 )内支架置入术治疗有心肌缺血症状心肌桥的可行性及疗效。方法 :共选择 10例有明显心肌缺血表现的心肌桥患者行支架置入术治疗。冠脉造影示心肌桥均位于前降支 ,心脏收缩时壁冠脉狭窄率 75 %～ 10 0 % ,狭窄长度 8～ 2 0mm。 8例置入Penta支架 ,2例置入CypherTM 支架。结果 :支架置入术的成功率为 10 0 % ,支架置入后即刻冠脉造影显示心肌桥压迫影像消失。术中有 1例发生了壁冠脉穿孔 ,后经球囊原位长时间低压力扩张封堵破孔终止了局部出血。术后所有患者的心绞痛症状均明显减轻或完全消失。在 4～ 13个月的随访期间 ,有 3例置入Penta支架的患者再发心绞痛 ,其中 1例作了重复冠脉造影 ,证实其支架内发生了 95 %的再狭窄。 2例置入了CypherTM支架的患者一直无症状 ,其中 1例复查了冠脉造影并获得了非常满意的造影结果。结论 :对有症状的心肌桥患者冠脉内支架置入术是可选的治疗方法 ,尤其对药物治疗无效或有禁忌的患者更为适用。支架术的近期疗效非常满意 ;远期效果不太理想 ,使用CypherTM支架有可能使此结果得到明显改善。由于支架置入术有引起壁冠脉破裂穿孔的危险 ,术前应权衡利弊 ,严格选择病例。
Objective:To evaluate the efficacy and feasibility of intracoronary stenting in patients with symptomatic myocardial bridge.Method:Intracoronary stenting was performed in 10 myocardial bridge patients with objective signs of myocardial ischaemia. Coronary angiography(CAG) showed there were 75%～100% systolic narrowing in the intramural coronary segment of the left anterior descending coronary artery in all patients. The length of intramural coronary segment was in the range of 8～20 mm. Eight patients were implanted with Penta stents and 2 with Cypher TM stents.Result:All procedures were successful. CAG showed absence of systolic compression along the intramural coronary segment after stenting. Intramural coronary perforation was seen in a case and recoverd through low-pressure and long-time balloon dilation at the site. Angina was obviously relieved or disappeared in all patients after stenting. During 4～13 months clinical follow-up, Angina recurred in 3 patients implanted with Penta stents, of one was found in-stent restenosis of 95% by repeat CAG. The 2 patients implanted with Cypher TM stents remained free of symptoms. Repeat CAG was obtained in one of them and showed an excellent angiographic result.Conclusion:Intracoronary stenting appears to be an alternative to treat patients with symptomatic myocardial bridge, especially for those resistant to medical therapy. Its immediate results are rather satisfactory. But its mid-and long-term results are not ideal and may be improved with Cypher TM stents. Stenting in intramural coronary segment may be complicated by perforation. Risks and benefits of this therapeutic option, therefore, have to be critically evaluated, and carefull selection of the patients is recommended.
出处
《临床心血管病杂志》
CAS
CSCD
北大核心
2004年第6期332-334,共3页
Journal of Clinical Cardiology
关键词
心肌桥
冠状动脉造影
支架
Myocardial bridge
Coronary angiography
Stents
