自发性冠状动脉夹层1例

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1临床资料患者女性,61岁,因间断性胸骨后疼痛1个月人院.既往17年前患急性前间壁心肌梗死,经保守治疗,病情好转,此后无胸痛发作.1个月前再发胸痛.否认高血压、糖尿病病史;无吸烟史.查体:心肺查体无异常.心电图:V1、V2、V3导联为QS型,T波倒置.心脏超声检查:左室舒末径54 mm,EF 56%,E/A<1.冠状动脉造影:前降支近中段弥漫性狭窄60%,狭窄的病变内可见一长约30 mm条形透亮区.建议患者行血管内超声(IVUS)检查,患者拒绝,并要求介人治疗,导丝顺利通过病变,植入3.0 mm x36 mm、3.5 mm×15 mm两枚支架,支架贴壁良好,心肌梗死溶栓试验(TIMI)3级.术后患者无心绞痛发作.
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