冠状动脉慢性闭塞病变内膜下支架植入术的临床疗效

doi:10.16138/j.1673-6087.2021.04.002

摘要/Abstract

摘要：

目的：评价冠状动脉（冠脉）慢性闭塞病变内膜下支架植入术的临床疗效。方法：自2016年1月至2019年1月,73例在我院成功行冠脉支架植入的慢性完全闭塞（chronic total occlusion,CTO）病变的患者为研究对象, 所有患者均经血管内超声（intravascular ultrasound,IVUS）证实有一段支架处于内膜下,但支架近端和远端均处于真腔中,全部患者均详细记录其临床和生化指标。详细记录所有患者的临床特征、住院期间和1年随访期间的主要不良心血管事件（major adverse cardiovascular event,MACE）（包括死亡、心绞痛复发、支架内再狭窄及因心肌缺血所致的再次血运重建等）。结果：在1年随访期间无死亡病例, 2例心肌梗死, 9例心绞痛复发, MACE发生率为15%。此外,13例（18%）患者发生支架内再狭窄,其中11例（15%）患者再次因心肌缺血行血运重建。结论：冠脉CTO病变内膜下支架植入术是可行、有效的。

关键词: 慢性完全闭塞, 内膜下, 支架, 主要不良心血管事件

Abstract:

Objective To evaluate clinical effect of subintimal stent implantation in the patients with chronic total occlusion(CTO) in coronary artery. Methods From January 2016 to January 2019, 73 patients with CTO in coronary artery who underwent coronary stent implantation successfully in our hospital were selected as the research objects. Intravascular ultrasound(IVUS) confirmed that a segment of the stent was in the false lumen (subintimal), but the proximal and distal parts of the stent were in the true lumen. The clinical and biochemical indexes of all patients were recorded in details. The clinical characteristics, major adverse cardiac events (MACE) (including death, angina recurrence, in-stent restenosis, and revascularization due to myocardial ischemia) during hospitalization and one-year follow-up were carefully noted. Results During one-year follow-up period, there were no death cases, 2 cases of myocardial infarction, 9 cases of angina recurrence, and the incidence of MACE was 15%. In addition, 13(18%) patients had in-stent restenosis, and 11 (15%) patients underwent revascularization due to myocardial ischemia again. Conclusions The subintimal stent implantation is feasible and effective approach for chronic coronary artery occlusion.

Key words: Chronic total occlusion, Subintimal, Stent, Major adverse cardiac events

中图分类号:

R541.4

胡健, 杨震坤, 闫小响, 倪钧, 丁风华. 冠状动脉慢性闭塞病变内膜下支架植入术的临床疗效[J]. 内科理论与实践, 2021, 16(04): 230-233.

HU Jian, YANG Zhenkun, YAN Xiaoxiang, NI Jun, DING Fenghua. Clinical effect of subintimal stent implantation in the patients with chronic total occlusion in coronary artery[J]. Journal of Internal Medicine Concepts & Practice, 2021, 16(04): 230-233.

图/表 1

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再狭窄病例特征	术后即刻例数	再狭窄例数
ADR	53(73)	10(19)
反向CART	20(27)	3(15)
支架在内膜下长度≥2 cm	6(8)	3(50)
支架远端血管直径≤2 mm	5(7)	3(60)
术后TIMI 2级血流	8(11)	5(63)
≥3个支架	11(15)	4(36)