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目的总结经皮冠状动脉介入治疗(PCI)术中冠状动脉穿孔的临床特点。方法回顾性分析2004年4月至2006年8月阜外心血管病医院PCI术中发生的32例冠状动脉穿孔患者的临床资料。结果32例冠状动脉穿孔患者占同期7102例PCI患者的0.5%。病变特点按美国心脏病学会(ACC)/美国心脏协会(AHA)标准进行分型,其中B2+C型病变占81.3%,慢性完全闭塞病变占62.5%。冠状动脉穿孔的Ellis分型:Ⅰ型14例(43.8%),Ⅱ型10例(31.2%),Ⅲ型8例(25.0%)。发生原因:钢丝引起21例(65.6%),球囊预扩张引起6例(18.8%),球囊后扩张引起3例(9.4%),支架置入引起2例(6.2%)。处理措施:鱼精蛋白中和肝素14例(43.8%),穿孔近端球囊封堵9例(28.1%),心包穿刺引流7例(21.9%),置入带膜支架4例(12.5%),急诊外科修补加冠状动脉旁路移植术(CABG)2例(6.2%)。预后:死亡3例(9.4%),急诊外科修补加CABG2例(6.2%),急性心脏压塞6例(18.8%),迟发性心脏压塞1例(3.1%),急性心肌梗死9例(28.1%)。结论Ⅲ型冠状动脉穿孔后果严重,需积极处理。
Objective To summarize the clinical features of coronary artery perforation during percutaneous coronary intervention (PCI). Methods The clinical data of 32 patients with percutaneous coronary artery perforation who had undergone PCI at Fu Wai Hospital from April 2004 to August 2006 were retrospectively analyzed. Results 32 cases of coronary perforation accounted for 0.5% of the 7102 PCI patients in the same period. The pathological features were classified according to the American College of Cardiology (ACC) / American Heart Association (AHA) criteria, in which 81.3% were B2 + C lesions and 62.5% were chronic total occlusion lesions. Ellis classification of perforation of coronary artery: 14 cases (43.8%) of type Ⅰ, 10 cases (31.2%) of type Ⅱ, and 8 cases (Ⅲ) of 8 cases (25.0%). Causes: Steel wire caused 21 cases (65.6%), balloon dilation caused 6 cases (18.8%), balloon dilatation caused 3 cases (9.4%), stent placement caused 2 cases (6.2%). Treatment: protamine and heparin in 14 cases (43.8%), perforation of the proximal balloon occlusion in 9 cases (28.1%), pericardial drainage in 7 cases (21.9%), placement of stent graft in 4 cases (12.5% ), Emergency surgical repair plus coronary artery bypass grafting (CABG) in 2 cases (6.2%). Prognosis: Three deaths (9.4%), emergency surgical repair plus CABG in 2 (6.2%), acute cardiac tamponade in 6 (18.8%), delayed cardiac tamponade in 1 (3.1%) and acute myocardial infarction in 9 (28.1%). Conclusion Severe perforation of type Ⅲ coronary artery requires active treatment.