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经皮腔内冠状动脉成形术(PTCA)及支架置入术的当前实践及其在不稳定型和稳定型心绞痛中的长期疗效。

The current practice of percutaneous transluminal coronary angioplasty (PTCA) and stent deployment and their long-term results in unstable and stable angina.

作者信息

Raju B Soma, Rao Nitin K

机构信息

Division of Cardiology, Care Hospitals, Hyderabad 500001.

出版信息

J Indian Med Assoc. 2003 Feb;101(2):66-70.

Abstract

Percutaneous transluminal coronary angioplasty with stent implantation is a universally accepted therapeutic option for patients with coronary artery disease. Since introduction in 1977, angioplasty techniques have been greatly improved; the availability of better hardware, greater operator experience, better patient selection and the judicious use of adjunctive therapy like heparin, clopidogrel, platelet receptor antagonists like abciximab and the use of atherectomy/rotablator in given situations has greatly improved procedural outcome today. Angioplasty alleviates symptoms in patients with stable angina and also in unstable angina especially in high risk patients like those with pulmonary oedema, cardiogenic shock or patients refractory to conventional modes of therapy, though cost may be a prohibiting factor. The outcome of angioplasty in diabetic patients is universally poor and bypass surgery is always a better option. Women with coronary artery disease tend to have complex lesions with a sub-optimal outcome and a higher incidence of restenosis. Use of abciximab is always beneficial in both men and women.

摘要

经皮腔内冠状动脉成形术及支架植入术是冠心病患者普遍接受的治疗选择。自1977年引入以来,血管成形术技术有了很大改进;更好的硬件设备、术者更丰富的经验、更合理的患者选择以及肝素、氯吡格雷等辅助治疗药物的合理使用,阿昔单抗等血小板受体拮抗剂的应用,以及在特定情况下使用旋切术/旋磨术,都极大地改善了如今的手术效果。血管成形术可缓解稳定型心绞痛患者的症状,也能缓解不稳定型心绞痛患者的症状,尤其是对于那些高风险患者,如伴有肺水肿、心源性休克的患者或对传统治疗方式耐药的患者,不过费用可能是一个限制因素。糖尿病患者血管成形术的效果普遍较差,搭桥手术始终是更好的选择。患有冠状动脉疾病的女性往往有复杂病变,手术效果欠佳且再狭窄发生率较高。使用阿昔单抗对男性和女性都有益处。

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