冠状动脉内支架治疗左主干病变二例(摘要)
作者：陈绍良 段宝祥 耿其吉 叶飞 许泓瑜 查铭凡 刘玲玲
单位：江苏省，南京市第一医院 心脏科(210006)
关键词：
中国循环杂志99zk55 目的：探讨冠状动脉内支架术治疗左主干病变的方法和可行性。
方法：4例左主干(LMD)患者，2例在主动脉内球囊反搏(IABP)下行急诊冠状动脉旁路移植术。例3为急性前壁心肌梗塞，前降支(LAD)Seg7 99%狭窄伴心肌梗塞溶栓治疗临床试验(TIMI)，血流1级，左主干远端狭窄75%并涉及前降支及回旋支开口。采用双导丝技术，先球囊预扩及支架置入恢复Seg7处的正常血流，后用对吻球囊预扩近端病变，之后用kissing支架法留置，大一号球囊做对吻后扩张支架。例4为不稳定性心绞痛，左主干自开口完全闭塞，由右冠状动脉发出的丰富侧支向左冠状动脉供血。采用逐次更换导丝，由软至硬，使之确切定位于LAD血管内后，再更换成软导丝，球囊由近至远扩张，再于主干及LAD内置入支架后用高压大号球囊做后扩张。
, http://www.100md.com
结果：例3即刻造影示残余狭窄0%，例4即刻造影示残余狭窄5%，左主干内支架造成回旋支(LCX)开口处20%狭窄，2例即刻近期疗效佳。
结论：无保护左主干经皮冠状动脉腔内成形术(PTCA)术的危险性大，但只要适应证选择恰当，术者技术熟练，部分LMD可做PTCA术。一般开口或体部的病变为PTCA最适宜对象。短时间、高压扩张是关键，短支架可防止支架堵塞LCX开口。
Coronary Stenting of “Unprotected" Left Main Coronary Stenosis: A Two Case Report (Abstract) (Abstract)
Department of Cardiology, Nanjing First Municipal Hospital, Nanjing (210006), Jiangsu
, 百拇医药
Chen Shaoliang, Duan Baoxiang, Geng Qiji, et al.
Objective: To study the methods and feasibility of stenting for “unprotected" left main coronary (LM) stenosis.
Methods: Among 4 cases of left main coronary diseases (LMD), two of them were treated with CABG, the other two were teated with angioplasty. One case was with acute myocardial infarction in anterior wall with an angiographic 75% stenosis of terminal LM which involved ostia of LAD and LCX, and a subtotal occlusion with TIMI grade 1 was presented in LAD Seg7. The patient was treated with double wires in LAD and LCX respectively, and reperfusing Seg. 7 by balloon pre-dilation and stenting firstly; then kissing balloon, kissing stenting and post-inflation by double larger balloons for LM. The other case was unstable angina pectoris (UAP) with angiographic total occlusion of LM starting from its ostium and with collaterals between RCA and left coronary system. To ensure the wire being in LAD, we changed the wire from soft type to hard type, finally changed back to super-soft wire during the procedure. Balloon was inflated from the proximal to the terminal, and stents were implanted in LM and LAD.
, http://www.100md.com
Results: Residual stenosis was 0% and 5% in patient with AMI and patient with UAP respectively, but new 20% stenosis in ostium of LCX caused by stent occurred in the patient with UAP. Both patients had got good immediate and short-term clinical outcome.
Conclusion: With proper indication selection and excellent skills, some parts of LMD can be treated with coronary angioplasty, though there are high risk factors in unprotected LM. Generally speaking, the indications for angioplasty are lesions located at the ostium and middle part of LM. Short time with high pressure inflation is the key to the success. Using short stents can avoid the occlusion of the ostium of LCX., 百拇医药
单位：江苏省，南京市第一医院 心脏科(210006)
关键词：
中国循环杂志99zk55 目的：探讨冠状动脉内支架术治疗左主干病变的方法和可行性。
方法：4例左主干(LMD)患者，2例在主动脉内球囊反搏(IABP)下行急诊冠状动脉旁路移植术。例3为急性前壁心肌梗塞，前降支(LAD)Seg7 99%狭窄伴心肌梗塞溶栓治疗临床试验(TIMI)，血流1级，左主干远端狭窄75%并涉及前降支及回旋支开口。采用双导丝技术，先球囊预扩及支架置入恢复Seg7处的正常血流，后用对吻球囊预扩近端病变，之后用kissing支架法留置，大一号球囊做对吻后扩张支架。例4为不稳定性心绞痛，左主干自开口完全闭塞，由右冠状动脉发出的丰富侧支向左冠状动脉供血。采用逐次更换导丝，由软至硬，使之确切定位于LAD血管内后，再更换成软导丝，球囊由近至远扩张，再于主干及LAD内置入支架后用高压大号球囊做后扩张。
, http://www.100md.com
结果：例3即刻造影示残余狭窄0%，例4即刻造影示残余狭窄5%，左主干内支架造成回旋支(LCX)开口处20%狭窄，2例即刻近期疗效佳。
结论：无保护左主干经皮冠状动脉腔内成形术(PTCA)术的危险性大，但只要适应证选择恰当，术者技术熟练，部分LMD可做PTCA术。一般开口或体部的病变为PTCA最适宜对象。短时间、高压扩张是关键，短支架可防止支架堵塞LCX开口。
Coronary Stenting of “Unprotected" Left Main Coronary Stenosis: A Two Case Report (Abstract) (Abstract)
Department of Cardiology, Nanjing First Municipal Hospital, Nanjing (210006), Jiangsu
, 百拇医药
Chen Shaoliang, Duan Baoxiang, Geng Qiji, et al.
Objective: To study the methods and feasibility of stenting for “unprotected" left main coronary (LM) stenosis.
Methods: Among 4 cases of left main coronary diseases (LMD), two of them were treated with CABG, the other two were teated with angioplasty. One case was with acute myocardial infarction in anterior wall with an angiographic 75% stenosis of terminal LM which involved ostia of LAD and LCX, and a subtotal occlusion with TIMI grade 1 was presented in LAD Seg7. The patient was treated with double wires in LAD and LCX respectively, and reperfusing Seg. 7 by balloon pre-dilation and stenting firstly; then kissing balloon, kissing stenting and post-inflation by double larger balloons for LM. The other case was unstable angina pectoris (UAP) with angiographic total occlusion of LM starting from its ostium and with collaterals between RCA and left coronary system. To ensure the wire being in LAD, we changed the wire from soft type to hard type, finally changed back to super-soft wire during the procedure. Balloon was inflated from the proximal to the terminal, and stents were implanted in LM and LAD.
, http://www.100md.com
Results: Residual stenosis was 0% and 5% in patient with AMI and patient with UAP respectively, but new 20% stenosis in ostium of LCX caused by stent occurred in the patient with UAP. Both patients had got good immediate and short-term clinical outcome.
Conclusion: With proper indication selection and excellent skills, some parts of LMD can be treated with coronary angioplasty, though there are high risk factors in unprotected LM. Generally speaking, the indications for angioplasty are lesions located at the ostium and middle part of LM. Short time with high pressure inflation is the key to the success. Using short stents can avoid the occlusion of the ostium of LCX., 百拇医药