冠状动脉介入治疗术后局部缺血防治进展

经皮冠状动脉成形术(PTCA)术后局部缺血并发症包括:急性冠状动脉闭塞,发生率2%~10%,病人的死亡率随之增加。由于侧支闭塞或血栓形成,围手术期心肌梗塞发生率5%~20%。急性冠脉综合症、老年病人、复合病变患者、围手术期并发症大大增加,直接支架植入有效防治急性冠脉闭塞,但仍然存在血栓形成等并发症,合用阿司匹林和抗血小板因子(抵克力得、氯吡格雷、阿昔单抗、依替巴肽、替罗非班)能降低局部缺血的发生率,已成为PTCA病人标准的辅助治疗

Progress in the Treatment of Ischemic Complications After Percutaneous Transluminal Coronary Angioplasty

The ischemic complications of percutaneous transluminal coronary angioplasty(PTCA) include abrupt closure,which occurs in 2% to 10% of patients,and is associated with increased morbidity and mortality.Periprocedural myocardial infarction due to side branch occlusion or embolization occurs in 5% to 20% of patients.Patients with acute coronary syndromes,older age,and complex lesions are at greater risk of periprocedural complications.Technical advances,primarily stenting,are useful in the prevention and management of acute closure,but are also accompanied by thrombotic complications.It remains to be seen whether the new antithrombin agents reduce the rate of periprocedural complications if used in combination with aspirin and new antiplatelet therapies.These antiplatelet agents(ticlopidine,clopidogrel,abciximab,eptifibatide,and tirofiban) reduce the rate of ischemic complications and have become standard adjunctive therapy for patients who undergo PTCA.