自发性冠状动脉夹层治疗策略与远期预后的相关性研究

目的回顾性分析自发性冠状动脉夹层(SCAD)患者的发病特点、治疗策略的选择。方法回顾性分析2005年1月~2015年2月于包头市中心医院心内科行冠状动脉造影患者共4413例,诊断SCAD患者9例,使用冠状动脉夹层的分类标准对夹层进行分类,分析不同类型的SCAD的发生率、影像特点及临床随访结果。结果 9例患者中,3例(33.3%)发生2处夹层,共存在12处夹层。8例(88.9%)发生临床事件,无症状1例(11.1%)。Ⅰ型夹层10处(83.3%),Ⅱ型夹层1处(8.3%),Ⅲ型夹层1处(8.3%)。6例中9处保守治疗,2例2处病变给予经皮冠状动脉介入治疗(PCI),1例存在2支冠状动脉夹层,1支介入治疗,1支药物保守治疗。3处病变PCI治疗成功,6例Ⅰ型夹层患者药物治疗6~12个月后复查冠状动脉造影,夹层无明显变化;1例Ⅰ型夹层患者药物治疗3个月,仍有心绞痛,给予PCI治疗;2例Ⅱ型夹层患者药物保守治疗12个月复查冠状动脉造影可见壁间血肿好转。结论 SCAD可以分3型。Ⅰ型夹层部分患者可以选择介入治疗,但存在操作的风险;Ⅱ型夹层(壁间血肿)选择药物保守治疗预后乐观。可以根据病变的类型、长度,选择性地采取PCI治疗。部分SCAD患者选择药物保守治疗预后比较乐观。但仍需长期观察随访效果,了解夹层愈合情况。     

自发性冠状动脉夹层的介入治疗结果分析

目的了解自发性冠状动脉夹层病变(SCAD)及其介入治疗。方法回顾性研究10例SCAD患者,介入治疗9例,了解治疗并发症以及预后。结果 8例患者在冠状动脉夹层处直接植入支架;1例患者导引导丝始终未能进入血管真腔,放弃介入治疗,改为开胸冠状动脉搭桥治疗。1例未予介入干预,仅药物治疗。行冠状动脉支架介入治疗患者随访3个月~2年,未发生心绞痛或心肌梗死等心脏事件。所有患者均存活。结论介入治疗可以作为冠状动脉自发夹层病变治疗的有效方法之一,但SCAD患者的治疗是选择内科药物保守治疗、冠状动脉介入治疗还是冠状动脉搭桥术,应根据冠状动脉造影时夹层的范围、形态、夹层阻塞血管的程度及对血流的影响等因素而决定。     

老年StandfordB型主动脉夹层患者冠状动脉造影的临床意义

目的探讨老年StandfordB型主动脉夹层患者中冠状动脉粥样硬化性心脏病（冠心病）的检出率及其相关危险因素。方法回顾性分析134例50岁以上同时进行主动脉造影和冠状动脉造影的StandfordB型主动脉夹层患者的临床资料及影像学资料．对数据进行统计分析。结果134例患者中,冠心病的检出率为26．1％（35例）,其中单支病变22例（16．4％）,2支病变9例（6．7％）,左主干或3支病变4例（3．0％）。多因素Logistic回归分析显示．男性（OR=6．682,95％CI1．01—44．13,P=0．049）及吸烟（OR=3．513,95％CI1．05-11．70,P=0．041）是StandfordB型主动脉夹层合并冠心病的预测因素。结论50岁以上StandfordB型主动脉夹层患者共患冠心病的比例较高,在主动脉造影时有必要常规进行冠状动脉造影检查,以免漏诊。     

自发性冠状动脉夹层临床特点分析

目的:通过回顾性分析自发性冠状动脉夹层(spontaneous coronary artery dissection, SCAD)患者的临床特点,进一步探讨其诊治策略。方法:回顾阜外医院2004年1月至2017年11月期间,病历系统中诊断为冠状动脉夹层的病例58例,共发现SCAD患者24例,对其临床资料、影像学特征及随访结果进行分析。结果:24例SCAD患者平均年龄(48.1±13.3)岁,女性8例(33.3%),18例(75.0%)以急性冠状动脉综合征起病。冠状动脉造影共发现28处夹层病变,病变类型均为1型,15处(53.6%)病变累及右冠状动脉,有4例(16.7%)患者合并多支冠状动脉夹层。TIMI血流3级22处(78.6%)病变血管中有6处行血运重建治疗,而TIMI血流小于3级的6处病变中有4处行血运重建治疗。初始血运重建策略为经皮冠状动脉介入治疗(PCI)的患者6例(25.0%),冠状动脉旁路移植术和溶栓治疗均为2例(8.3%),余14例(58.3%)患者给予药物保守治疗。21例患者成功进行随访,随访时间中位数为31个月,发生主要不良心脑血管事件1例(4.2%,脑梗死)。结论:SCAD患者经常以急性冠状动脉综合征起病,多数患者可以选择药物保守治疗。     

211例冠状动脉心肌桥的血管造影特点及临床分析

目的：探讨冠状动脉造影人群中冠状动脉心肌桥的造影特点及治疗。方法：回顾性分析接受选择性冠状动脉造影1762例患者的临床资料。结果：在1762例行选择性冠状动脉造影人群中,发现心肌桥211例（12．0％）,其中202例（95．7％）发生于左前降支（LAD）,仅2例（0．9％）见于左回旋支（LCX）,7例（3．3％）见于右冠状动脉（RCA）;收缩期狭窄〈50％有79例（37．4％）,50％～75％的有106例（50．2％）,〉75％有26例（12．3％）;53例（25．1％）有典型心绞痛症状,29例（13．7％）为心肌梗死患者;所有患者均应用B受体阻滞剂或钙通道阻滞剂治疗,其中孤立性心肌桥患者140例（66．4％）患者症状明显改善;合并单支病变的35例（16．6％）,双支病变的13例（6．2％）患者,在行PCI术后给予口受体阻滞剂及钙通道阻滞剂治疗,患者症状明显改善。结论：心肌桥常见于于左前降支,部分有典型的心绞痛,无论是否对冠脉狭窄进行了PCI手术,钙离子拮抗剂及B受体阻滞剂均可缓解症状。     

原发性冠状动脉夹层的造影特点及介入治疗

目的　了解原发性冠状动脉夹层 (SCAD)的发生情况及介入治疗的效果。方法　分析 22 16例冠状动脉造影以发现SCAD ;对适合经皮冠状动脉介入治疗术 (PCI)的SCAD患者行支架置入术 ,手术前后及手术中按要求使用阿司匹林、氯吡格雷、肝素或低分子肝素等药。结果　发现SCAD共 2 6例 ,男 19例 ,女 7例 ,平均年龄 (6 0 9± 11 6 )岁 (34～ 75岁 ) ,检出率为 1 17%。其中急性心肌梗死 15例 ,不稳定型心绞痛 11例。 2 6例患者共 2 8支血管发生SCAD。其中冠状动脉左主干 1例 ,左前降支 9例 ,回旋支 4例 ,右冠状动脉 14例。对适合PCI术的 18例患者 19支血管撕裂处行支架置入术。其中 14例 15处行经皮腔内冠状动脉成形术 (PTCA) 支架置入术 ,4例行直接支架置入术。撕裂处共置入支架 2 3枚。支架置入术后 ,1例冠状动脉原发性撕裂处残余狭窄小于 30 % ,另 1例残余狭窄小于 10 % ,其余 16例均无残余狭窄。经介入治疗后患者的临床症状均明显缓解。结论　SCAD并非罕见 ,存在冠状动脉粥样斑块者是SCAD相对高发的人群。支架置入术是治疗SCAD较为理想的方法。     

自发性冠状动脉夹层的临床特征及腔内影像学评估

目的回顾性分析自发性冠状动脉夹层(spontaneous coronary artery dissection,SCAD)患者的发病特点和腔内影像学特征,探讨血管内超声(intravenous ultrasound,IVUS)和光学相干断层成像(optical coherence tomography,OCT)在其诊断和治疗中的应用价值。方法回顾性分析2012年8月至2018年3月南京市第一医院经IVUS或OCT确诊为SCAD的17例患者,借助SCAD冠状动脉造影分型对病变进行分类,分析不同类型SCAD患者影像学特点及临床随访事件。结果 17例SCAD患者中,临床表现为急性ST段抬高型心肌梗死7例(7/17),非ST段抬高型心肌梗死5例(5/17),不稳定型心绞痛5例(5/17)。冠状动脉造影病变累及左前降支14例(14/17),左回旋支2例(2/17),右冠状动脉1例(1/17)。SCAD分型示Ⅰ型2例(2/17),Ⅱ型10例(10/17),Ⅲ型5例(5/17)。17例患者中,10例(10/17)行IVUS检查,11例(11/17)行OCT检查,其中4例同时行IVUS和OCT检查。IVUS和OCT均能清晰显示撕裂的内膜片及分隔开的真腔和假腔。4例(4/17)患者接受经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI),13例(13/17)患者接受药物保守治疗。4例(4/17)患者1年后再次来院复查冠状动脉造影及IVUS,其中2例接受PCI的患者支架通畅,IVUS检查示支架贴壁良好;另2例接受药物治疗的患者IVUS检查示夹层消失。所有患者在随访期间未发生任何缺血事件。结论SCAD是临床少见的一类急性冠状动脉综合征,应用IVUS和OCT有助于准确评估SCAD,进而为SCAD治疗策略的选择提供一定依据。     

自发性冠状动脉夹层所致急性冠状动脉综合征的临床与预后研究

目的:分析自发性冠状动脉夹层(SCAD)所致急性冠状动脉综合征(ACS)患者的临床资料,以积累该病的诊疗经验。方法:选择经冠状动脉造影(CAG)或冠状动脉影像学检查明确诊断为SCAD所致的ACS患者为研究对象,分析其病历资料和CAG资料,对其临床特征、冠状动脉影像学特征、治疗策略和随访结果进行分析。结果:共入选18例患者,其中ST段抬高型心肌梗死(STEMI)5例(27.7%),非ST段抬高型心肌梗死(NSTEMI)3例(16.7%),不稳定性心绞痛10例(55.6%);患者平均年龄(47.5±12.3)岁,其中女性13例(72.2%),合并2种以上冠心病危险因素的患者仅7例(38.9%);冠状动脉夹层的分型以1型病变10例(55.6%)为主,18例患者共发现23处夹层病变,5例(27.7%)合并多支冠状动脉夹层病变,其中12处(52.2%)病变累及前降支(LAD),7处(30.4%)病变累及旋支(LCX),4处(17.4%)病变累及右冠状动脉(RCA);患者治疗策略以药物保守治疗13例(72.2%)为主,经过12个月的随访,血运重建2例(11.1%),再次心肌梗死1例(5.6%),其余15例在随访中无任何严重主要不良心脑血管(MACCE)事件发生。结论:SCAD所致的ACS患者多为年轻女性,且合并冠心病危险因素较少,患者经药物保守治疗后近期预后良好。     

冠状动脉临界病变是否支架治疗的临床预后比较研究

目的观察和比较冠状动脉临界病变的非心肌梗死患者,采用介入、药物两种不同治疗方案的临床预后。方法选取2005年12月-2009午9月于我院住院的非心肌梗死冠心痛患者,经冠状动脉造影（CAG）证实为冠状动脉临界病变患者105例。根据患者意愿是否行冠状动脉内介入治疗将患者分为介入治疗组（PCI组）51例和单纯药物治疗组（MT组）54例,临床观察6～18个月内稳定心绞痛、不稳定心绞痛及心血管不良事件（心肌梗死,冠状动脉内血运重建,心源性死亡）发生情况。结果PCI组和MT组共发生心血管不良事件4例,PCI组发生1例为心脏性死亡,MT组发生3例为再次血运重建术。两组患者稳定型心绞痛的发生率分别为31．4％和37．0％,不稳定型心绞痛的发生率分别为19．6％和29．6％。以上比较差异均无统计学意义（P〉0．05）。结论冠状动脉临界病变患者行PCI与MT治疗相比发生心绞痛及心血管不良事件无显著差异。     

冠状动脉支架内慢性完全闭塞病变介入治疗的长期疗效

目的总结冠状动脉支架内慢性完全闭塞（in—stent chronicto tal occlusion，ISCTO）病变应用经皮冠状动脉介入治疗（percutaneous coronary intervention。PCI）的技术及长期疗效。方法回顾性分析ISCTO135例的临床、介入手术资料及术后长期随访结果，总结PCI治疗技术及经验。结果PCI病变成功率93．2％（136／146），病例成功率94．1％（127／135）。单纯经皮腔内球囊血管成形术（percutaneous transcoronary angioplasty，PTCA）23例（17．0％）。再次置人支架112例（83．0％）。置人的112枚支架中药物洗脱支架94枚（83．9％）。具有支架内闭塞时间超过6个月、绝对性闭塞、闭塞部位呈刀切状、有分支发出、闭塞长度在15mm或以上、病变近端或病变处弯曲在45。或以上特征的ISCTO病变较不具备这些特征的病变PCI成功率降低（88．2％与97．4％，89．7％与98．3％，81．8％与98．0％，82．9％与97．1％，87．8％与98．6％，86．2％与97．7％，P〈0．05）。8例患者10处病变PCI操作失败，其中导丝不能通过ISCTO病变7处，球囊不能跨越病变2处，开通血管后发生无复流1处。术中发生心室颤动1例，急性左心衰竭1例，均处理成功。术后住院期间无主要不良心脏事件发生，心绞痛症状缓解率为89．0％。临床随访4～78个月，造影随访72例（53．3％），发现心绞痛复发23例（17％），靶血管重建16例（11．9％），心脏性猝死4例（3．0％）。结论ISCTO成功PCI因素包括合适的手术时机、适当的手术器械选择及术者的经验及决策。手术难度虽大，但一旦成功，患者将明显受益。     

Idiopathic spontaneous coronary artery dissection: incidence, diagnosis and treatment

BACKGROUND: Less is known about characteristics, treatment and follow-up of patients with spontaneous coronary artery dissection (SCAD) without associated pregnancy or underlying atherosclerosis. METHODS: We reviewed 5054 consecutive coronary angiographies for SCAD in patients without atherosclerosis or associated pregnancy and performed follow-up angiography in eligible patients. RESULTS: SCAD were assessed in five patients (mean age 44 +/- 8.7 years). Interestingly, all were premenopausal women. Three had no cardiovascular risk factors, whereas two were previous smokers and one had slightly elevated cholesterol levels. Clinical presentation was acute myocardial infarction in four cases and unstable angina pectoris in one of them. Dissection was localized in the left anterior descending artery (LAD) in three cases and in the first marginal branch of the left circumflex artery in two cases. Three patients were treated conservatively with antithrombotic therapy and beta-blocker, whereas in one patient rescue-PCI with stenting of the ostium of the LAD was performed after failed thrombolysis. The fifth woman with dissected proximal LAD underwent CABG. Follow-up angiographies after 5.9 +/- 4.4 months showed complete angiographic resolution of the dissection in the medically treated patients and a perfect angiographic result of the stented LAD. All patients were free of symptoms after a mean follow-up of 13 +/- 10 months. CONCLUSIONS: Idiopathic SCAD is a rare cause of acute coronary syndrome in premenopausal women. In case of single vessel dissection and normal blood flow of the dissected vessel, medical treatment with aspirin, clopidogrel and beta-blockade leads to complete angiographic resolution within a few months.     

SafeCut球囊处理分叉病变分支血管的疗效和安全性观察

目的评价SafeCut球囊成形术治疗冠脉分叉处分支血管中病变的安全性及疗效方法。方法42例冠心病患者46个分叉病变主支病变置入支架,分支病变单行SafeCut,球囊扩张而不置入支架,观察其手术过程,手术成功率,并发症和近期随访结果。结果42例患者46个分叉病变中位于前降支/第一对角支占62%,回旋支/钝圆支占29%,右冠脉/后降支或后侧支占10%。对分支血管行SafeCut球囊扩张后有2例因内膜严重撕裂而置入支架,其余病变残余狭窄为10%～50%,成功率达100%,无急性心肌梗死等严重并发症。术后临床随访6～20个月,无死亡及心肌梗死等心脏事件发生。结论SafeCut球囊成形术治疗冠脉分叉处分支血管病变安全,有效,其成功率高,并发症少,近期疗效满意。     

Case report: a very large dissection in the left anterior descending coronary artery of a 56-year-old man

Spontaneous coronary artery dissection (SCAD) is a rare condition that usually occurs in relatively young patients who are predominantly female. Seldom it could be a cause of acute myocardial ischemia leading to a sudden cardiac death. SCAD consists of intramural hematoma formation or, rarely, intimal tears that initiate and propagate the dissection in the vessel wall. In rare cases, the SCAD occurs in male patients. We report the case of a 56-year-old man with acute myocardial infarction who was successfully treated via systemic thrombolysis in a peripheral hospital. Associated conditions were thrombosis of right femoral artery in the past and high platelet count (800,000/mm³). After 1 month, elective coronary angiography revealed a very diffuse spiral dissection of the left anterior descending artery; hence, our choice of medical treatment consisted of double oral antiplatelet therapy (clopidogrel 75 mg plus aspirin 325 mg once daily). After a 2-year follow-up, there was absence of both angina and myocardial ischemia and there was a decrease in platelet count. Many strategies could be considered in patients with SCAD, such as PCI, bypass surgery, or conservative medical management. In general, the long-term prognosis of patients with SCAD is considered favorable if they survive the acute phase.     

Prospective study of the incidence, pathogenesis and therapy of spontaneous, by coronary angiography diagnosed coronary artery dissection

Spontaneous coronary artery dissection is a rare cause of ischemic heart disease. Incidence, etiology and optimal treatment are ill-defined. Between July 1995 and December 1997, we prospectively identified 42 patients (36 men, six women, mean age 59 +/- 12 years) with spontaneous coronary artery dissection among 3803 consecutive angiographic examinations in which the diagnosis of coronary artery disease was established for the first time (incidence 1.1%). In comparison to the remaining study population with stable angina pectoris (8 cases of spontaneous coronary artery dissection among 2852 patients; incidence: 0.3%), the incidence of spontaneous coronary artery dissection was significantly higher in the patient subgroups with acute myocardial infarction (13/450; 2.9%) and with unstable angina pectoris or postinfarction angina (21/501; 4.2%). Dissection was most frequently located in the left anterior descending coronary artery (19 cases), followed by the right coronary artery (15 cases) and the left circumflex coronary artery (8 cases). Because of an ambiguous angiographic lesion appearance intravascular ultrasound imaging was performed in 13 patients to confirm the diagnosis. The presumed etiology of spontaneous coronary artery dissection was atherosclerotic plaque rupture in 35 cases, heavy physical exercise in four cases and hormonal influences related to pregnancy and contraception in one case. In two cases, no obvious risk factor could be identified. Therapy consisted of intracoronary stenting in 24 patients (including ten patients with acute myocardial infarction), coronary artery bypass grafting (CABG) in 8 patients and balloon angioplasty (PTCA) in seven patients. Three patients were treated conservatively. During a mean follow-up period of 13.5 +/- 9.9 months, two patients died and 31 patients remained entirely asymptomatic, including all patients who were treated with CABG. Restenosis developed in three patients after stent implantation (restenosis rate: 12.5%). Following primary PTCA, spontaneous coronary artery dissection recurred in two patients, one of whom subsequently died.     

Presentation and therapy of spontaneous coronary artery dissection and comparisons of postpartum versus nonpostpartum cases

Predisposing risk factors, clinical course, and prognosis of spontaneous coronary artery dissection (SCAD) remain poorly understood. We reviewed medical records and coronary angiograms of patients admitted to our institution with the diagnosis of SCAD from 1999 through 2010. A definite diagnosis of SCAD required the agreement of 2 blinded board-certified interventional cardiologists who reviewed all images separately. Baseline characteristics of patients (n = 23) included mean age 45 ± 11 years, female gender in all (100%), history of hypertension in 13 (57%), and postpartum in 7 (30%). Eleven (48%) had ST-segment elevation on initial electrocardiogram. SCAD involved the left main in 5 patients (21.7%), left anterior descending coronary artery in 16 (70%), left circumflex coronary artery in 8 (35%), and right coronary artery in 6 (26%). Four patients (17%) underwent coronary stenting and 6 (26%) required urgent bypass surgery. Comparison between postpartum and nonpostpartum patients revealed significant differences in mean peak troponin levels: 50 ± 34 ng/ml vs 21 ± 23, p = 0.04, mean left ventricular ejection fraction: 34 ± 6% vs 49 ± 9, p <0.01, proximal coronary segment distribution: 6 (86%) vs 3 (19%), p = 0.004, and left anterior descending coronary artery distribution: 7 (100%) vs 9 (56%), p = 0.04, respectively. Repeat coronary angiographies were performed in 11 patients (46%) during a mean follow-up of 39 ± 38 months and 10 (91%) were found to have healed SCAD, including those who had undergone bypass surgery. In conclusion, our patients with SCAD were characterized by female gender, absence of coronary risk factors, and a high rate of vascular healing without residual stenosis. Larger infarct was found in postpartum patients.     

冠状动脉心肌桥342例临床特点及预后分析

目的:探讨冠状动脉心肌桥的临床特点。方法:2009年1月~2011年12月在我院住院的患者,通过冠脉CT或冠脉造影检查诊断心肌桥342例。结果:其中表浅型232例,占67.8%。118例表浅型心肌桥患者伴有胸闷症状,61例深在型心肌桥患者伴有胸闷症状,无统计学差异;深在型肌桥患者心电图ST-T异常发生率较表浅型明显增高(P0.05),两者患高血压病、糖尿病、高脂血症、心肌病发病率无统计学差异。深在型心肌桥较表浅型再发心绞痛发生率较高(P0.05)。临床药物治疗包括倍他洛克、钙离子拮抗剂、硝酸酯、他汀、阿司匹林、氯吡格雷,两者间没有统计学差异,非药物治疗包括介入治疗和外科手术治疗。结论:心肌桥并非罕见,心肌桥与临床心绞痛、动脉粥样硬化、心肌梗死、致死性心律失常有关。药物治疗包括β受体阻断剂、钙离子拮抗剂。外科治疗仍有争议,包括搭桥和肌桥松解术。     

Therapeutic dissection after successful coronary balloon angioplasty: no influence on restenosis or on clinical outcome in 693 patients. The MERCATOR Study Group (Multicenter European Research Trial with Cilazapril after Angioplasty to prevent Transluminal Coronary Obstruction and Restenosis).

OBJECTIVES: The objective of this study was to examine the relation between an angiographically visible coronary dissection immediately after successful coronary balloon angioplasty and a subsequent restenosis and long-term clinical outcome. BACKGROUND. The study population comprised all 693 patients who participated in the MERCATOR trial (randomized, double-blind, placebo-controlled restenosis prevention trial of cilazapril, 5 mg two times a day). METHODS. Cineangiographic films were processed and analyzed at a central angiographic core laboratory, without knowledge of clinical data, with use of an automated interpolated edge detection technique. Dissection was judged according to the National Heart, Lung, and Blood Institute classification. Angiographic follow-up was obtained in 94% of patients with 778 lesions. Two approaches were used to assess the restenosis phenomenon: 1) categoric, using the traditional cutoff criterion of greater than 50% diameter stenosis at follow-up, and 2) continuous, defined as absolute change in minimal lumen diameter (mm) between the postcoronary angioplasty and follow-up, adjusted for the vessel size (relative loss). Clinical outcome was ranked according to the most serious adverse clinical event per patient during the 6-month follow-up period, ranging from death, nonfatal myocardial infarction, coronary revascularization and recurrent angina requiring medical therapy to none of these. RESULTS. Dissection was present in 247 (32%) of the 778 dilated lesions. The restenosis rate was 29% in lesions with and 30% in lesions without dissection (relative risk 0.97; 95% confidence interval 0.77 to 1.23). The relative loss in both groups was 0.10 (mean difference 0; 95% confidence interval -0.03 to 0.03). Clinical outcome ranged from death in 4 patients (0.9%) without dissection and 1 patient (0.4%) with dissection; nonfatal myocardial infarction in 4 (0.9%) without and 8 (3.2%) with dissection; coronary revascularization in 73 (16.6%) without and 32 (12.7%) with dissection; recurrent angina requiring medical therapy in 88 (20%) without and 47 (18.7%) with dissection to no serious adverse event in 272 (61.7%) without and 114 (65.1%) with dissection. CONCLUSIONS. These data indicate that a successfully dilated coronary lesion with an angiographically visible dissection is no more likely to develop restenosis, and is not associated with a worse clinical outcome, at 6-month follow-up than is a dilated lesion without visible dissection on the post-balloon angioplasty angiogram.     

Primary percutaneous coronary intervention in a case of idiopathic spontaneous coronary artery dissection

Spontaneous coronary artery dissection (SCAD) is a rare but important cause of acute coronary syndrome. SCAD can cause unstable angina, acute myocardial infarction, and sudden death. The diagnosis of coronary dissection is usually made by coronary angiography. Therapeutic options include medical therapy, percutaneous coronary intervention, and bypass surgery. A 23-year-old male patient presented with acute inferior wall myocardial infarction. He was taken for primary percutaneous coronary intervention and found to have long segment SCAD in the right coronary artery. He was stented with 2 drug-eluting stents; TIMI 3 flow was restored; and the patient had an uneventful, complete recovery.     

西罗莫司洗脱支架治疗冠心病弥漫长病变的疗效观察

目的观察西罗莫司洗脱(CYPHERTM)支架治疗冠状动脉弥漫长病变的安全性及近、远期疗效。方法回顾性分析53例冠状动脉弥漫长病变患者应用CYPHERTM支架进行经皮冠状动脉介入治疗的临床资料,着重分析治疗方法、结果、并发症和随访结果。结果 53例患者中,61处靶病变共植入79个CYPHERTM支架。在61处靶病变中直径≤2.5mm的病变12处(20%,12/61),支架内再狭窄病变15处(25%,15/61),完全闭塞病变6处(10%,6/61)。53例患者行经皮冠状动脉介入治疗均获得成功,所有患者未见任何并发症。所有患者临床随访(24.0±8.5)个月,有3例症状再发,复发率5.6%(3/53),后经冠状动脉造影证实2例为支架内再狭窄所致,1例为晚期血栓形成,均需再次血运重建,再次血运重建率5.6%(3/53)。其余患者均未发生任何主要心血管事件。46例患者术后(24.0±9.8)个月复查了冠状动脉造影,造影随访率87%(46/53),支架近端边缘节段晚期管腔丢失(0.26±0.05)mm,支架内晚期管腔丢失(0.21±0.03)mm,支架远端边缘节段晚期管腔丢失(0.10±0.02)mm。病变再狭窄率3.3%(2/61)。结论 CYPHERTM支架治疗冠状动脉弥漫长病变安全、有效,近、远期疗效好。     

冠状动脉内支架置入术治疗老年患者复杂冠状动脉病变

目的　探讨经皮冠状动脉腔内支架置入术治疗老年患者复杂性冠状动脉病变的疗效及安全性。方法对 4 5例冠心病患者施行冠状动脉内支架置入术 ,病变血管共 5 8支 ,B型病变 4 9处 ,C型病变 1 3处 ,慢性完全闭塞病变 4处 ,共置入支架 64只。置入左前降支 2 7只 ,左回旋支 1 3只 ,右冠状动脉 2 4只。De Novo支架置入 4 4只 ,Suboptimal支架置入 1 5只 ,Bail-out支架置入 3只 ,再狭窄病变支架置入 2只。结果　术后经冠状动脉造影证实疗效满意 ,支架置入成功率为 98.4 %。术前病变平均直径狭窄 (86.5± 7.8) % ,术后残余直径狭窄 (5 .1± 1 0 .3 ) %。住院期间无亚急性支架血栓形成。 1例出现假性动脉瘤 ,1例在术中及术后出现三次心室颤动 ,4例患者术后心绞痛复发 ,复查冠状动脉造影发现了 3个支架节段血管有再狭窄。结论　对于老年冠心病患者复杂冠状动脉病变 ,经皮冠状动脉内支架置入术是一种安全有效的介入性治疗技术 ,其成功率高 ,并发症发生率低