冠状动脉二支主干堵塞行介入治疗完全血运重建

目的：本研究探讨对16例冠状动脉二支主干堵塞者采用分步和分次冠状动脉介入治疗术（PCI）完全血运重建的有效性和安全性。方法：（1）对5例急性心肌梗死（AMI），采取一次性分步直接PCI术完成血运重建；（2）对11例不稳定型心绞痛（UAP），采取多次性分步PCI术达到完全血运重建，首先解除本次发病罪犯血管的堵塞；（3）恰当使用XB导引导管、Crossit硬导丝和Maverick球囊以及主动脉内球囊反搏（IABP）支持。结果：（1）5例AMI二支堵塞冠状动脉均成功植入支架，并首先使左前降支（LAD）再通。（2）11例UAP中21／22支冠状动脉二支主干堵塞处经球囊预扩张后，均成功植入支架，所有堵塞冠脉均获得TIMI-Ⅲ级血流。（3）16例患者术后心电图显示心肌缺血明显改善，心脏超声显示左室射血分数较术前明显改善，由（42±34）％升至（51±44）％。经过平均18个月随访，患者生活质量明显提高，未发生严重心血管事件。结论：冠状动脉二支主干堵塞者行PCI术完全血运重建安全可行；对AMI者优先开通LAD的一次性PCI术安全高效；对慢性堵塞UAP者，优先开通近期罪犯病变的多次性PCI术既可达到完全血运重建，又符合临床实际。

Complete revascularization of total occlusion of two major coronary arteries by percutaneous coronary intervention

Objective：To evaluate the feasibility and efficiency of complete revascularization of two major occluded coronary arteries by percutaneous coronary intervention （PCI）. Methods： The direct PCIs for two acutely occluded major coronary arteries were performed consecutively in 5 patients with acute myocardial infarction （AMI） and left anterior descending artery （LAD） was revascularized firstly. Two-step PCIs （an interval of 1-2 weeks） were conducted for two chronically occluded major coronary arteries in 11 patients with unstable angina pectoris（UAP） and the artery of culprit lesion responsible for recent onset was first choice. XB guiding catheter, Crossit 100-200 guiding wire and Maverick balloon were used to enable PCI success. Results： Two occluded major coronary arteries were reopened and stented in 5 patients with AMI. Two-step PCIs were successful in 10 of 1 l patients with UAP. Another one＇s right coronary artery was stented successfully and distal LAD was well perfused by collateral circulation. XB guiding catheter, Crossit 100-200 guiding wire and Maverick balloon were used in all patients. Complete revascularization （TIMI-Ⅲ grade of blood flow） was achieved for all the 16 patients. After an average of 18 months of follow-up, chest pain disappeared, myocardial ischemia decreased, cardiac function improved and no major cardiovascular events were found in all patients. Conclusion：Complete revascularization of two occluded ma jor coronary arteries by PCI was feasible and effective. One-step PCI for acute occlusion of two major coronary arteries in AMI was safe and efficacious. Two step PCI for chronic occlusion of two major coronary arteries in UAP was essential and practical.