Miketić S, Carlsson J, Neuhaus K L, Bonzel T, Grube E, Tebbe U
Medizinische Klinik II Klinikum Lippe-Detmold.
Z Kardiol. 2000 Jun;89(6):508-12. doi: 10.1007/s003920070222.
In cases with protected left main stenosis by previous bypass surgery or as an emergency intervention in patients presenting with acute myocardial infarction and cardiogenic shock, percutaneous transluminal coronary angioplasty is performed as an alternative treatment strategy to bypass surgery. A review of 262 left main angioplasties revealed a procedure-related mortality in cases without protection of the left main coronary artery of 9.1% (4/44), in cases with partially protected left main stenosis by collaterals to either left coronary artery of 4.8% (1/21) and 0.5% (1/187) in cases with nonobstructed bypass grafts to either left coronary artery. Coronary angioplasty of an unprotected left main coronary artery, had an unacceptably high procedure-related mortality rate and should therefore not be performed even in cases of emergency intervention. The risk stratification of the procedure can be evaluated by the proposed grading of left main artery protection.
对于既往接受过搭桥手术而存在受保护的左主干狭窄的病例，或作为急性心肌梗死并心源性休克患者的紧急干预措施，经皮腔内冠状动脉成形术可作为搭桥手术的替代治疗策略。对262例左主干血管成形术的回顾显示，左主干冠状动脉未受保护的病例中与手术相关的死亡率为9.1%（4/44），左冠状动脉有侧支循环部分受保护的左主干狭窄病例中为4.8%（1/21），左冠状动脉有通畅搭桥移植物的病例中为0.5%（1/187）。未受保护的左主干冠状动脉进行血管成形术，其与手术相关的死亡率高得令人难以接受，因此即使在紧急干预的情况下也不应进行。该手术的风险分层可通过提议的左主干动脉保护分级来评估。
