经皮冠状动脉腔内成形术并发急性血管闭塞

目的：探讨急性血管闭塞的发生及治疗。方法：回顾总结我院１０３４例经皮冠状动脉腔内成形术（ＰＴＣＡ）的急性血管闭塞及治疗情况。结果：３１例（３．０％）患者发生急性血管闭塞，其中８例系急性心肌梗塞（ＡＭＩ）；１６例为不稳定性心绞痛，７例为稳定性心绞痛。发生急性血管闭塞的时间：２８例（９０．３％）患者在ＰＴＣＡ术中，３例在术后。９例患者因血压降低需用升压药，其中５例需主动脉内球囊反搏（ＩＡＢＰ）支持。４例急性血管闭塞时发生心室颤动，１例出现心室停搏。处理结果：３１例患者中２４例用球囊长时间加压；１８例植入支架；２５例治疗成功，成功率为８０．６％。２例（６．５％）死亡；３例（９．７％）发生心肌梗塞；１例（３．２％）急诊行冠状动脉旁路移植手术。结论：急性血管闭塞的发生与不稳定性心绞痛、多支血管病变、复杂病变有关，采取冠状动脉内支架及长时间加压治疗有助于减少并发症。

Acute Coronary Artery Occlusion Complicating Percutaneous Transluminal Coronary Angioplasty

Objective:Acute coronary artery occlusion after percutaneous transluminal coronary angioplasty (PTCA)continues to remain a serious complication.This retrospective study was performed to ascertain the freqency,management and outcome of acute coronary artery occlusion. Methods:This study was based on data from 1 034 consecutive patients who underwent elective and emergency PTCA in Fu Wai hospital.Abrupt occlusion occurred in 31 patients (3.0%). Results:There were 8 cases with acute myocardial infarction (AMI),16 cases with unstable angina,7 with stable angina.Abrupt occlusion developed during the dilatation procedure in 28 patients(90.3%)and in 3 patients within 6 hours after the procedure.There were 9 patients with haemodynamic instability(5 implanted with intra aortic balloon pump),4 with ventricular fibrillation,1 with heart arrest.The management of abrupt occlusion including immediate prolong dilatation(24 patients),stenting (18 patients)and use of intracoronary urokinase(4 patients)was successful(reduction of lumen diameter to<50.0%,no death,no MI and no emergency surgery)in 25 patients (80.6%).The overall mortality rate was 6.5%(2 patients),MI was 9.7% and emergency bypass surgery was 3.2%.At follow up,coronary angiography was repeated in 5 patients,only 2 patients with unstable angina showed restenosis. Conclusion:Abrupt occlusion is higher in patients with unstable angina,multivessel disease,and complex lesions.Stenting and prolong dilatation are helpful in management of abrupt occlusion.