Nayak A K, Davis R, Reddy H K, Krishnan M S, Voelker D J, Aggarwal K
Department of Internal Medicine, University of Missouri-Columbia, 65212, USA.
South Med J. 2000 Apr;93(4):415-23.
Coronary artery bypass surgery is a difficult option in patients who are not candidates for bypass surgery and high-risk patients with critical left main coronary artery (LMCA) disease. We report outcomes and short-term follow-up of patients who had LMCA rotational atherectomy and/or stenting, assess the role of these interventions in protected and unprotected significant LMCA stenosis, and review the literature.
We reviewed the cases of seven men with critical LMCA stenosis for whom coronary artery bypass surgery was considered a high risk. Five patients had rotational atherectomy, one had coronary artery stenting, and one had both.
In all cases, angiographic success was achieved, and symptoms were relieved. Six patients were discharged from the hospital in 3 to 6 days. One patient who had cardiogenic shock, respiratory failure, and acute renal failure before the procedure died of arrhythmia 4 days afterward. Another patient had elective coronary artery bypass graft surgery 3 weeks later for recurrent angina. Cardiac catheterization was repeated in 1 month for chest pain in three patients at 4 to 7 months follow-up, and none had progression of residual stenosis in the LMCA.
Our study suggests that LMCA rotational atherectomy and stenting are safe and effective revascularization procedures in high-risk patients and patients who are not candidates for bypass surgery.
对于不适合进行搭桥手术的患者以及患有严重左主干冠状动脉（LMCA）疾病的高危患者，冠状动脉搭桥手术是一项困难的选择。我们报告了接受LMCA旋磨术和/或支架置入术患者的治疗结果及短期随访情况，评估这些干预措施在有保护和无保护的严重LMCA狭窄中的作用，并对相关文献进行综述。
我们回顾了7例严重LMCA狭窄男性患者的病例，这些患者被认为进行冠状动脉搭桥手术风险较高。5例患者接受了旋磨术，1例接受了冠状动脉支架置入术，1例两者都接受了。
所有病例均取得血管造影成功，症状缓解。6例患者在3至6天内出院。1例术前出现心源性休克、呼吸衰竭和急性肾衰竭的患者在术后4天死于心律失常。另1例患者在3周后因复发性心绞痛接受了择期冠状动脉搭桥手术。3例患者在随访4至7个月时因胸痛于1个月后再次进行心脏导管检查，LMCA残余狭窄均未进展。
我们的研究表明，LMCA旋磨术和支架置入术对于高危患者以及不适合进行搭桥手术的患者是安全有效的血运重建方法。
