不稳定型心绞痛无保护左主干病变支架术后随访研究

目的　探讨冠状动脉内支架治疗无保护左主干病变 (LMD)的安全性及有效性。方法　2 7例LMD经球囊预扩张后置入支架。术后 6和 12个月行冠状动脉造影随访。结果　左主干开口病变 12例、体部 4例、末端 6例 (累及分叉开口 6例、单纯末端 1例 ) ,自开口到体部均狭窄者 5例 (含自开口处就完全闭塞 1例 )。术后 12个月时 ,左心室射血分数从 4 9 8%增加到 5 6 3% (P <0 0 5 )。球囊扩张时 2 0例 ( 6 2 % )出现显著心率减慢和血压下降。共置入 2 8枚支架 ,其中左主干内 2 7枚 ,主干内支架直径 ( 3 90± 0 4 7)mm、长度 ( 12 5 4± 3 95 )mm。全部患者均完成 12个月的临床随访 ,19例 ( 70 % )患者接受 6个月时冠状动脉造影 ,3例支架内再狭窄 ( 15 % ) ,其中 2例接受冠状动脉旁路术 ,1例行血管内放射治疗 ;术后 12个月时 15例 ( 5 5 % )行冠状动脉造影随访 ,1例再狭窄行冠状动脉旁路术 ,因此术后 12个月内累积再狭窄率为 2 1%。 4例再狭窄患者中 ,3例为末端病变 ( 75 % ) ,1例为开口病变( 2 5 % )。结论　冠状动脉内支架治疗LMD疗效可靠 ,冠状动脉造影随访可及时发现再狭窄。左主干末端病变再狭窄率显著。

Middle-term follow-up of coronary stenting for left main trunk stenosis

Objective To determine the effect of coronary stenting for unprotected left main stenosis (LMD) Methods Twenty seven patients with LMD was dilated with balloon followed by stenting Re angiography was performed 6 and 12 months later Results Twelve lesions located at the ostial, 4 at the body, 6 at the distal (true bifurcation lesion in 6 and false bifurcation in 1 lesion) and 5 involved from ostium to distal (including 1 chronic total occluded lesion involved from ostial to distal left main) In the 12 month follow up, left ventricular ejection fraction (LVEF) was increased from 49 8% to 56 3% ( P <0 05) Decreasing of heart rate and blood pressure during balloon inflation occurred in 20 cases, respectively Twenty seven stents were put in left main coronary artery with average diameter of 3 90 mm and average length of 12 54 mm Re angiography was performed at the end of 6 months in 19 patients (3 restenotic lesions, 15%) and at the end of 12 months in 15 patients (1 restenosis, with final total restenotic rate within 12 months being 21%) Of 4 patients with in stent restenosis, CABG was performed in 3 cases with distal lesions and intravascular irradiation was performed in 1 patient with ostial lesion Conclusion Left main coronary artery stenting was safe and feasible True distal LMD had higher restenotic rate compared to non distal lesions