10例冠状动脉穿孔患者置入带膜支架后的长期随访研究

目的评价带膜支架治疗经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)术中发生冠状动脉穿孔患者的长期疗效。方法从2004年6月至2012年6月,本中心共对10例PCI中发生冠状动脉穿孔后置入带膜支架的患者进行了随访,观察其主要心脏不良事件(major adverse cardiac events,MACE)发生率。置入带膜支架术后服用氯吡格雷75mg/d共2年,长期服用肠溶阿司匹林100mg/d。结果 10例患者中男性6例,女性4例;年龄(68.6±5.2)岁,范围60～76岁。置入带膜支架直径平均(3.3±0.3)mm,长度平均(22.1±3.7)mm,所有患者破口均被成功封闭,术中无死亡病例。随访时间(31.7±24.5)个月,范围0.6～67个月,1例术后19天因肺部感染导致多器官功能衰竭而死亡,1例术后13个月猝死;1例患者术后53个月出现心绞痛;1例术后6个月查多层CT示支架内无再狭窄;4例患者复查冠状动脉造影,只有1例患者在PCI术后67个月复查冠状动脉造影示左前降支(LAD)带膜支架内再狭窄;另3例病例带膜支架内均无再狭窄。住院期间死亡率为10%(1/10);PCI术后12个月,MACE发生率为10%(1/10);在整个随访期间靶血管再狭窄率为20%(1/5),死亡率为20%(2/10),MACE发生率为40%(4/10)。结论带膜支架治疗冠状动脉穿孔能达到较好的长期疗效,两年的双联抗血小板药物可能能有效预防带膜支架内血栓形成。

Long-term follow-up study of patients with covered stent implantation after coronary perforation

Objective To evaluate the long-term efficacy of covered stent implantation to the patients with coronary perforation occurred during percutaneous coronary intervention (PCI). Methods From June 2004 to June 2012, the major adverse cardiac events (MACE) of 10 cases who received covered stents implantation because of coronary perforation were observed through long-term follow-up. The patients took clopidogrel 75mg/d for 2 years, and aspirin 100mg/d for lifetime. Results There were 6 males and 4 females in the 10 patients who aged 60-76 (mean 68.6±5.2) years. Implanted covered stents average diameter was (3.3±0.3) mm, and average length was (22.1±3.7) mm. All perforation of the patients were successfully closed, while no patients died in PCI. During follow-up of 0.6-67 months (mean 31.7±24.5) months, 2 patients died. Nineteen days after PCI, one patient died of multiple organ failure due to lung infection. Thirteen months after PCI, another patient died of cardiac sudden death. One patient had angina pectoris after 53 months. After 6 months one patient received multi-slice CT examination, and no restenosis was found. There were four patients reviewing coronary angiography after 15-67 months. Only one patient showed LAD stent restenosis and recevied target vessel revascularization. The remaining 3 patients had no restenosis within the stent. mortality rate was 10% (1/10) in hospital. MACE rate was 10% (1/10) in 12 months after PCI. During the entire follow-up, restenosis rate was 20% (1/5), mortality rate was 20% (2/10), MACE rate was 40% (4/10). Conclusions Treatment of covered stent to coronary perforation can achieve good long-term efficacy. A two-year dual antiplatelet drugs can be effective in preventing covered stent thrombosis.