右冠状动脉成形术306例临床分析

摘要

目的分析评估右冠状动脉成形术(PTCA)和支架置入术的特点。方法总结1995年1月至1999年12月行右冠状动脉PTCA和支架置入术的冠心病患者306例。结果对306例右冠状动脉的338处病变行PTCA和支架置入术；17例失败，手术成功率为94.4%，支架置入成功率98.8%。其中严重夹层撕裂7例(包括2例急性心肌梗死和1例死亡)，因开口异常被迫中止手术1例，导丝不能通过闭塞病变9例，心包积血死亡1例，并发急性血栓形成2例，支架远端再撕裂2例。结论右冠状动脉因其开口位置和方向变异相对较大，走向和分支等解剖具有不同的特点，行PTCA和支架置入时必需考虑其特点，尽量减少并发症的发生。%Objective　To analysis the reasons of failures of percutaneous transluminal coronary angioplasty (PTCA) and stenting for patients with right coronary artery lesions (RCA). Methods　Three hundred six consecutive patients with right coronary artery lesions underwent PTCA and stenting, these acute results were reviewed. Results　PTCA and stenting were successfully performed with 338 lesions in 306 right coronary artery of patients except 17 cases failed for artery dissection, the occluded lesions that wires can′t traverse, and the abnormal ostiums. The procedure rate was 94.4%. Two patients died for hemopericardium and severe dissection; Four patient attacked by non-fatal Q-wave myocardial infarction due to severe arterial dissection in two cases and acute thrombogenesis occurring in 2 target lessions after stenting that confirmed by angiography.Conclusions　The procedures of PTCA and stenting for RCA is different from the other coronary arteries for their anatomy. In order to lower the complications, some of characteristic of RCA should be considered in procedures.