无保护左冠脉主干严重狭窄的雷帕霉素洗脱支架治疗

目的评价应用雷帕霉素洗脱支架治疗无保护冠状动脉左主干(LM)严重狭窄性病变(狭窄程度90%)的安全性及近期疗效。方法分析26例植入雷帕霉素洗脱支架治疗无保护冠状动脉LM严重狭窄性病变病人的一般临床资料、手术操作技巧、手术前后影像学结果、住院期间主要不良心性事件(MACEs,死亡、非致死性心梗、心绞痛复发等)发生、出院后随访结果等。结果该组患者均表现为急性冠脉综合征(表现AMI2例,不稳定性心绞痛和NSTMI24例);4例病变位于LM开口部,2例LM干段部,LM末端累积LAD3例,LM末端累及LCX3例,LM末端同时累及LAD和LCX者14例(占53.8%),属于前三叉分叉性病变20例(占76.9%);2例LM100%闭塞性病变,其余狭窄程度为90%~95%;所有患者住院期间无MACE发生;平均随访(13.3±8.8)个月(2.5~31个月),无1例死亡,MACE事件为0,1例患者术后13个月复查冠脉造影,原支架内未见狭窄。结论雷帕霉素洗脱支架治疗无保护冠状动脉左主干严重狭窄性病变是安全、有效的。

Rapamycin-eluting Stent for Unprotected Left Main Coronary Artery Serious Stenosis

Objective To evaluate the safety and short-term curative effect of the unprotected left main coronary artery serious stenosis treated by rapamycin-eluting stent. Methods We analyzed the general clinical data, operation skill and imaging results major adverse cardiac events（MACE, death, nonfatal myocardial infarction, etc） and recurrent angina during hospitalization and after discharge in 26 cases of the unprotected left main coronary artery serious stenosis treated by rapamycin-eluting stent implantation. Results In 26 cases of acute coronary syndrome, 2 cases were AMI and 24 cases were unstable angina pectoris and NSTMI, and 4 cases showed the lesions in LM openings, 2 cases, the lesion in the middle of LM, 3 cases, in the distal of LM and LAD, and 3 cases involved LCX. 14 cases（53.8%） showed the lesion of LM involving also LAD and LCX and 20 cases （76.9%） belonged to former trigeminal bifurcation lesion. 2 cases suffered from the total occlusion of LM （100%）, and 24 cases suffered from stenosis of 90%~95%. The MACE rate in all cases during hospitalization was 0%, and all the cases were followed-up for 6-31 months with an average of （13.3±8.8） months. No original in-stent stenosis was seen by coronary angiography 13 months after operation in one case. Conclusion It is safe and effective that the unprotected left main coronary artery serious stenosis is treated by rapamycin-eluting stent implantation.