介入治疗心肌桥和心肌桥并发严重冠状动脉粥样硬化病变的疗效观察

目的:探讨冠脉内药物支架置入治疗心肌桥及心肌桥并发严重冠状动脉粥样硬化病变的疗效。方法:对14例急性心肌梗死的心肌桥患者(冠状动脉造影示心肌桥均位于前降支,心脏收缩时血管狭窄75%～95%,病变长度为10～22mm。8例并发心肌桥近端冠状动脉粥样硬化伴狭窄和完全闭塞,5例为心肌桥以外冠状动脉粥样硬化伴狭窄和完全闭塞,1例为单纯心肌桥。)行吉威雷帕霉素药物支架于冠状动脉粥样硬化伴狭窄和完全闭塞及部分患者心肌桥处。结果:术中即刻造影示冠状动脉粥样硬化狭窄和闭塞处及置入支架的心肌桥压缩影像消失,血流恢复,TIMI3级,管腔无残余狭窄。随访3～18个月有3例再发心绞痛,经药物治疗后症状缓解。结论:对有心肌桥和心肌桥并发严重冠状动脉脉粥样硬化病变的患者,可以选择药物支架置入治疗,但远期疗效仍需更多的病例研究证实。

The evaluation on stent implantation efficacy of myocardial bridge and severe atherosclerosis lesions in the segments with myocardial bridge

Objective： To investigate the efficacy of intracoronary drug-stenting in patients with myocardial bridge and severe atherosclerosis lesions in the segments proximal to the myocardial bridge. Methods：Intracoronary drug-stenting was performed in 14 myocardial bridge patients with acute myocardial infarction. Coronary angiography showed there were 75-95% systolic stenosis 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 10-22 mm . Drug-stents were implanted in the criminal coronary segments of all patients and the intramural coronary segments of the parts of the patients with myocardial bridge. Results： After stenting,coronary angiography showed no residual stenosis in the segments. During 3- 18 months clinical follow-up, angina was recurred in 3 patients implanted with the stents ,of one was implanted with the stent in its intramural coronary segment and the segment proximal to the myocardial bridge, and of others only were implemented with stent in the criminal coronary segments. Their angina was disappeared in the 3 patients, after strengthening medical therapy. Conclusion： Intracoronary stenting appears to be an alternative to treat patients with myocardial bridge and myocardial bridge with severe coronary atherosclerosis lesions. But luther study in large populations is still necessary.