经皮冠状动脉介入术治疗冠状动脉慢性完全闭塞性病变疗效

目的总结经皮冠状动脉介入术治疗冠状动脉慢性完全闭塞（chronic total occlusion，CTO）的疗效。方法回顾性分析2006年12月前施行经皮冠状动脉介入术的临床资料。结果冠状动脉慢性完全闭塞233例．共有靶血管251支，闭塞时间（20±10）个月。226例（226／251，96．9％）的237处靶病变（237／251，94．4％）行经皮冠状动脉介入术成功。共植入冠状动脉支架266枚。因导丝不能通过CTO病变未成功7例：造影提示病变类型均为旁路侧支血管丰富型或多处长的弯曲病变，其中2例闭塞时间有5年以上，另5例未开通患者中有2例因心功能不全不能耐受长时间手术而终止操作。术中及术后均无严重并发症。术后心绞痛症状缓解率85．4％，心功能改善率79．6％，5年生存率88．9％。结论冠状动脉慢性完全闭塞行经皮冠状动脉介入术成功关键在于熟练的操作技术、合理的器材选择及仔细评估病人和动脉闭塞病变状况；开通闭塞动脉可显著改善患者临床症状，提高生活质量。

Efficacy of percutaneous coronary intervention on chronic total coronary occlusion

Objectives To evaluate the effects and clinic outcomes of pereutaneous coronary intervention （PCI） on chronic total occlusion （ CTO ） in coronary lesions. Methods The data of 233 patients undergoing PCI for a CTO before December 2006 were analyzed. Results PCI was performed successfully in 233 CTO patients with history of （20±10） months, including target vessels 251. Two hundred and sixty-six stents were implanted. Operative failures occurred in 7 patients, owing to failure to pass through the occlusion. The improvement rate of angina pectoris was 85.4% （P〈0.01）, while the improvement rate of cardiac functions was 79.6% （P〈0.01）, survival rate in five years was 88.9%. Conclusions Careful evaluation on CTO lesion is a key to obtain a relatively high success rate of PCI. Exquisite operating and select equipment are also important. A successful PCI for CTO improves the clinical symptoms and the life quality of patients.