冠状动脉支架脱载及其处理(摘要)
作者：马长生 颜红兵 王勇 周玉杰 李宪伦 郑知刚 李宵 柯元南
单位：北京市，中日友好医院 心内科(100029)
关键词：
目的 目的：报告4例冠状动脉支架脱载，旨在总结经验和提高预防和处理的能力。
方法和结果：①病例 1995年8月至1999年6月共对327例397处冠状动脉狭窄行支架置入术。按常规操作完成冠状动脉造影和经皮冠状动脉腔内成形术(PTCA)，并根据造影结果决定置入支架。结果在327例397处病变共置入15种425个支架。A型病变16.4%,B1型病变29.5%,B2型病变39.8%,C型病变14.4%。支架脱载4个(0.9%),分别为Bestent 4.0 mm×15.0 mm、AVE 3.0 mm×15.0 mm和Crossflex LC 3.0 mm×27.0 mm(2个)。②脱载原因 例3和例4均因偏心性长病变预扩张不够充分，使得支架不能通过病变或深插指引导管损伤了左主干。回顾分析，如果将指引导管送过右冠状动脉开口处支架后再释放第2个支架，应能避免例1的支架脱载。例2的支架脱载是由于术者间配合不当导致支架误释放。③脱载处理 例1和例2由于没有微细线圈摘取器，故将脱载支架送入下肢动脉分支。例4因支架进退两难，故原地释放。使用微细线圈摘取器取出例3的脱载支架。
, 百拇医药
结论：支架脱载是较棘手的并发症，如处理不当，可产生严重后果，如本文例4。为防止发生，要求术者具有较高的综合素养，正确判断靶血管病变解剖特点，选择恰当的支架、指引导管及导丝，并进行充分的预扩张。发生脱载时，要冷静地考虑包括冠状动脉旁路移植术在内的各种处理措施，首先应考虑采用简单、安全和行之有效的微型线圈摘取器摘取法。
Coronary Stent Migration and its Management (Abstract)
Department of Cardiology, China-Japan Friendship Hospital, Beijing (100029)
Ma Changsheng, Yan Hongbing, Wang Yong, et al.
Objective: To present coronary stent migrations in 4 cases in order to improve an ability to prevent and manage them.
, 百拇医药
Methods and Results: ① From August, 1995 to June, 1999, 397 stenosis in 327 cases were treated with implantation of 425 coronary stents. Of 397 stenosis, type A lesions accounted for 16.4%, type B1 lesions 29.5%, type B2 lesions 39.8% and type C lesions 14.4%. Four stents were migrated with an incidence of 0.9% (4/425) including one Bestent (4.0 mm×15.0 mm) stent, on AVE (3.0 mm×15.0 mm) stent and two Crossflex LC (3.0 mm×27.0 mm) stents. ② Probable causes of stent migration. In cases 3 and 4, it was a failed stent passing through a stenosis because of a poor predialation of a long eccentric stenosis or an injured left main coronary artery resulted from an excess inserting. After a retrospective analysis, we believe that the stent migration could have been prevented in case 1 if the second stent was not delivered until a guiding catheter passed through the first stent located at ostium of the right coronary artery. The stent migration in case 2 resulted from a poor cooperation between operators. ③ Migration management. In cases 1 and 2, 2 migrated stents were pushed into a branch of a limb artery because of unavailable microcoil retrieval. In case 4, the migrated stent was delivered right at the spot because it was difficult to be moved either for word or backward. In case 3, the migrated stent was successfully removed from the artery by using the microcoil retrieval.
, http://www.100md.com
Conclusion: A stent migration is one of the complications hard to cope with during a coronary stenting procedure. If a proper management could not be achieved, a severe complication would happen as in case 4. Therefore, an improvement of operators′ general skills, an understanding of characteristic anatomy of a target vessel, a proper selection of stents, guiding catheters and guide wires, and an adequate predilation are needed to prevent a stent migration. When a migration occurs, all available management procedures including bypass surgery should be considered, and a microcoil retrieval technique, which has been proven to be a simple, safe and effective method, should be tried at first., 百拇医药
单位：北京市，中日友好医院 心内科(100029)
关键词：
目的 目的：报告4例冠状动脉支架脱载，旨在总结经验和提高预防和处理的能力。
方法和结果：①病例 1995年8月至1999年6月共对327例397处冠状动脉狭窄行支架置入术。按常规操作完成冠状动脉造影和经皮冠状动脉腔内成形术(PTCA)，并根据造影结果决定置入支架。结果在327例397处病变共置入15种425个支架。A型病变16.4%,B1型病变29.5%,B2型病变39.8%,C型病变14.4%。支架脱载4个(0.9%),分别为Bestent 4.0 mm×15.0 mm、AVE 3.0 mm×15.0 mm和Crossflex LC 3.0 mm×27.0 mm(2个)。②脱载原因 例3和例4均因偏心性长病变预扩张不够充分，使得支架不能通过病变或深插指引导管损伤了左主干。回顾分析，如果将指引导管送过右冠状动脉开口处支架后再释放第2个支架，应能避免例1的支架脱载。例2的支架脱载是由于术者间配合不当导致支架误释放。③脱载处理 例1和例2由于没有微细线圈摘取器，故将脱载支架送入下肢动脉分支。例4因支架进退两难，故原地释放。使用微细线圈摘取器取出例3的脱载支架。
, 百拇医药
结论：支架脱载是较棘手的并发症，如处理不当，可产生严重后果，如本文例4。为防止发生，要求术者具有较高的综合素养，正确判断靶血管病变解剖特点，选择恰当的支架、指引导管及导丝，并进行充分的预扩张。发生脱载时，要冷静地考虑包括冠状动脉旁路移植术在内的各种处理措施，首先应考虑采用简单、安全和行之有效的微型线圈摘取器摘取法。
Coronary Stent Migration and its Management (Abstract)
Department of Cardiology, China-Japan Friendship Hospital, Beijing (100029)
Ma Changsheng, Yan Hongbing, Wang Yong, et al.
Objective: To present coronary stent migrations in 4 cases in order to improve an ability to prevent and manage them.
, 百拇医药
Methods and Results: ① From August, 1995 to June, 1999, 397 stenosis in 327 cases were treated with implantation of 425 coronary stents. Of 397 stenosis, type A lesions accounted for 16.4%, type B1 lesions 29.5%, type B2 lesions 39.8% and type C lesions 14.4%. Four stents were migrated with an incidence of 0.9% (4/425) including one Bestent (4.0 mm×15.0 mm) stent, on AVE (3.0 mm×15.0 mm) stent and two Crossflex LC (3.0 mm×27.0 mm) stents. ② Probable causes of stent migration. In cases 3 and 4, it was a failed stent passing through a stenosis because of a poor predialation of a long eccentric stenosis or an injured left main coronary artery resulted from an excess inserting. After a retrospective analysis, we believe that the stent migration could have been prevented in case 1 if the second stent was not delivered until a guiding catheter passed through the first stent located at ostium of the right coronary artery. The stent migration in case 2 resulted from a poor cooperation between operators. ③ Migration management. In cases 1 and 2, 2 migrated stents were pushed into a branch of a limb artery because of unavailable microcoil retrieval. In case 4, the migrated stent was delivered right at the spot because it was difficult to be moved either for word or backward. In case 3, the migrated stent was successfully removed from the artery by using the microcoil retrieval.
, http://www.100md.com
Conclusion: A stent migration is one of the complications hard to cope with during a coronary stenting procedure. If a proper management could not be achieved, a severe complication would happen as in case 4. Therefore, an improvement of operators′ general skills, an understanding of characteristic anatomy of a target vessel, a proper selection of stents, guiding catheters and guide wires, and an adequate predilation are needed to prevent a stent migration. When a migration occurs, all available management procedures including bypass surgery should be considered, and a microcoil retrieval technique, which has been proven to be a simple, safe and effective method, should be tried at first., 百拇医药