论文部分内容阅读
目的:探讨冠状动脉成形术中冠状动脉破裂的可能原因。方法:对所有介入治疗前的靶病变行定性和定量造影分析,并选择在发生冠状动脉破裂前最近一次的血管内超声(IVUS)图像进行分析。结果:在5个心脏介入中心总共1 506例经皮冠状动脉成形术(PCI)患者中,发生冠状动脉破裂15例(1.0%),其中6例与操作导丝相关,1例与单纯球囊扩张相关,8例与支架植入相关。6例与导丝相关的破裂均由亲水涂层或中等硬度导丝所致,靶病变包括3例闭塞、4例偏心和3例分叉病变。与球囊或支架相关冠状动脉破裂包括6例偏心、6例中等至严重钙化病变。有血管内超声分析的5例,其病变偏心率均小于0.4,钙化弓在42~109度。除了单纯球囊破裂病例,在所有支架植入导致的破裂,球囊/管腔比值均超过1.3。所有与导丝相关冠状动脉破裂属于EllisⅡ级,与球囊或支架相关的2例属Ⅱ级,7例属Ⅲ级。结论:导丝相关的冠状动脉破裂常发生在采用亲水涂层或中等硬度导丝对偏心、分叉或闭塞病变进行操作;球囊或支架相关冠状动脉破裂经常与球囊尺寸过大或压力过大有关,常发生在偏心和伴钙化的病变处。
Objective: To investigate the possible causes of coronary artery rupture during coronary angioplasty. METHODS: Qualitative and quantitative angiographic analysis of all pre-interventional target lesions was performed and the most recent intravascular ultrasound (IVUS) images prior to coronary artery rupture were selected for analysis. RESULTS: Coronary artery rupture occurred in 15 (1.0%) patients in a total of 1 506 percutaneous transluminal coronary angioplasty (PCI) patients at 5 cardiac interventional centers, of which 6 were associated with operative guidewire and 1 with simple balloon Expansion related, 8 cases and stent implantation related. Six cases of wire-related rupture caused by the hydrophilic coating or moderate hardness guide wire, the target lesions, including three occlusions, four cases of eccentric and three cases of bifurcation lesions. Coronary artery rupture associated with balloon or stent included 6 eccentric and 6 moderate to severe calcified lesions. There are 5 cases of intravascular ultrasound analysis, the lesion eccentricity is less than 0.4, calcification bow at 42 to 109 degrees. Except for cases of simple balloon rupture, balloon / lumen ratios exceeded 1.3 in all stent-implanted ruptures. All of the wire associated with coronary artery rupture belongs to the Ellis Ⅱ level, and balloon or stent-related 2 cases are grade Ⅱ, 7 cases are grade Ⅲ. CONCLUSIONS: Guiding wire-related coronary artery rupture often occurs when eccentric or bifurcated or occluded lesions are treated with a hydrophilic coating or a medium-hardness guidewire. Balloon or stent-associated coronary arteries are often ruptured with excessive balloon size or pressure Excessive, often occurs in eccentric and calcification lesions.