Farell Campa J, Palomo Villada J A, Abundes Velasco A, Ledesma Velasco M
Hospital de Cardiología del Centro Médico Nacional Siglo XXI del Instituto Mexicano del Seguro Social, México, D.F.
Arch Inst Cardiol Mex. 2000 Jan-Feb;70(1):38-45.
We examined the immediate and short-term outcomes after stenting protected and unprotected left main coronary artery (LMCA) stenoses, in patients with normal ventricular function. Left main coronary artery disease is regarded as an absolute contraindication for coronary angioplasty, because it has been associated with high procedural morbidity and poor mid-term results. Between february 1995 and february 1999, 596 procedures were performed in 468 patients. Ten patients who had disease involving the left main coronary artery were included. They were not candidates for coronary surgery. The post-stent antithrombotic regimens were aspirin and ticlopidine. The procedural success rate was 100% without episodes of subacute thrombosis. Three to six months follow-up angiography was performed in all, restenosis occurred only in two patients, there were two repeat PTCA (20%) and there were no deaths.
Stenting of unprotected and protected left main coronary artery stenoses may be a safe and effective alternative to surgery in carefully selected patients with normal left ventricular function. The results of our study suggests that when patients have prohibitive surgical risks, elective LMCA angioplasty and/or stenting maybe undertaken with a high procedural success rate as an effective alternative to CABG in carefully selected patients. Further studies in larger patient populations are needed to assess late outcome.
我们研究了在心室功能正常的患者中，对受保护和未受保护的左主干冠状动脉（LMCA）狭窄进行支架置入后的即刻和短期结果。左主干冠状动脉疾病被视为冠状动脉血管成形术的绝对禁忌症，因为它与高手术发病率和不良中期结果相关。1995年2月至1999年2月期间，对468例患者进行了596例手术。纳入了10例患有左主干冠状动脉疾病的患者。他们不适合进行冠状动脉手术。支架置入后的抗血栓治疗方案为阿司匹林和噻氯匹定。手术成功率为100%，无亚急性血栓形成事件。所有患者均进行了3至6个月的随访血管造影，仅2例患者发生再狭窄，有2例重复PTCA（20%），无死亡病例。
在精心挑选的左心室功能正常的患者中，对未受保护和受保护的左主干冠状动脉狭窄进行支架置入可能是一种安全有效的手术替代方法。我们的研究结果表明，当患者存在极高的手术风险时，对于精心挑选的患者，选择性LMCA血管成形术和/或支架置入术可作为冠状动脉旁路移植术（CABG）的有效替代方法，手术成功率较高。需要对更多患者进行进一步研究以评估晚期结果。
