主动脉夹层合并冠心病的联合介入治疗（附8例报告）

目的评价覆膜支架联合PCI治疗Stanford B型主动脉夹层合并冠心病的安全性和有效性。方法2005年1月至2007年7月完成的8例覆膜支架联合PCI治疗Stanford B型主动脉夹层合并冠心病患者，首先完成主动脉夹层覆膜支架置入术，3～7d后完成PCI。观察住院期间及随访期间疗效。结果经左桡动脉行主动脉造影：夹层破裂口位于左锁骨下动脉外缘0～10mm 1例、11～30mm 4例，31～50mm 3例，其中1例有2个破裂口，余7例均为单破裂口。7例主动脉夹层向下累及肾动脉及其以下的血管。1例置入Talent支架，7例置入Aegis支架，共8枚（直径34—38mm，长度100—140mm）。1例覆膜支架封闭左锁骨下动脉，术后无上肢和脑缺血症状。覆膜支架置入成功率100％。术后即刻造影：4例近端破裂口完全封堵，4例少量残余内漏。术后住院期间2例胸背部仍有疼痛，复查增强螺旋CT，原内漏无扩大，经对症止痛逐渐好转，无截瘫、死亡等并发症发生。冠状动脉造影证实8例中单支病变4例，2支病变3例，3支病变1例。靶病变平均狭窄85．6％±14．0％．靶血管参考直径2．8±0．3mm。对11支靶血管共置入12枚支架，其中1例于前降支置入2枚相连支架。支架平均长度23．5±13．6mm。PCI即刻成功率100％，无PCI相关严重并发症发生。随访期1～31个月（平均18．0±8．5个月），8例均存活，无迟发内漏或需二次手术者及不良心脏事件发生。结论覆膜支架联合PCI治疗StanfordB型主动脉夹层合并冠心病安全可行，手术成功率高，术后患者恢复快，冠状动脉PCI的抗凝治疗未对大动脉支架术后构成不良影响，更长期的疗效需进一步随访观察。

Successive interventional treatment of thoracic aortic dissection and coronary heart disease

Objective To evaluate the effectiveness and safety of successive interventional treatment in patients with thoracic aortic dissection and coronary heart disease by endovascular graft exclusion （EVGE） and pereutaneous coronary intervention （PCI） respectively. Methods From January, 2005 to July, 2007, 8 patients with Stanford B aortic dissection and coronary heart disease received successive EVGE and PCI in our centre. All patients were performed with EVGE 3 - 7 days prior to their PCI. Results The site of dissection tears were confirmed by aortic angiography which located within 0 - 10 mm from the exterior margin of left subclavian artery in 1 patient, 11 - 30 mm in 4 patients and 31 - 50 mm in 3 patients. One patient had two tear gaps. Dissection of or distal to the renal .arteries were involved in 7 patients. Talent graft （Medtronie Corporation, U. S. ） was used in one patient and Aegis grafts （Mierosport Medical Corporation, China） in 7 patients. Eight trunk rectorial membrane stents were used with lengths ranged from 100 to 140 mm with diameters ranged from 34 to 38 mm. Left subclavian artery was thoroughly covered by the proximal section of the graft in one patient, which resulted in a weak left radial artery pulse but with no obvious ischemic symptom of the left upper limb and brain. Procedures were technically successful in all patients and no severe complication such as death, paraplegia, and kidney insufficiency occurred after the procedure during hospitalization. Post-procedural aortography showed no leakage in 4 patients and minor leakage in 4 patients. Two patients had residual thoracic back pain which could be relieved by drugs. Coronary angiography showed that 4 patients had single-vessel disease, 2 had double-vessel disease and one had triplevessel disease. The mean stenosis rate of the target lesions was 85.6% ± 14. 0% and the mean diameter of the reference vessels was 2. 8 ± 0. 3 mm. Twelve stents were inplanted in 11 target vessels in 8 patients. The mean length of stents was 23