Cripps T R, Morgan J M, Rickards A F
Royal Brompton National Heart and Lung Hospital, London.
Br Heart J. 1991 Jul;66(1):3-6. doi: 10.1136/hrt.66.1.3.
A total of 32 (3.6%) patients of 880 undergoing coronary angioplasty during a nine year period at one hospital had extensive dissection (defined as a dissection extending beyond the limits of the dilated angioplasty balloon) in the coronary artery in which the angioplasty procedure was performed. Two (6.25%) of the 32 patients (both of whom were undergoing angioplasty because of unstable angina that was refractory to medical treatment) died as a consequence of the coronary artery dissection. Twelve (38%) needed immediate coronary artery bypass surgery and 11 (34%) had a myocardial infarction, which in four was minor in extent. During follow up, 20 of the 32 patients were successfully managed by medical treatment; only two needed further angioplasty procedures. There were no late deaths. Extensive coronary artery dissection is a serious complication of coronary angioplasty, with a high early mortality and a high incidence of infarction and requirement for bypass surgery. None the less, patients with extensive dissection who are free from the manifestations of acute ischaemia at the end of the procedure can be managed conservatively and have a good immediate and medium term outlook. Attempts should be made to stabilise extensive dissection during coronary angioplasty so that surgical intervention can be delayed or avoided altogether if possible.
在一家医院九年期间接受冠状动脉成形术的880例患者中，共有32例（3.6%）在进行成形术的冠状动脉中发生了广泛夹层（定义为夹层延伸超出扩张的成形术球囊范围）。32例患者中有2例（6.25%）（两人均因药物治疗无效的不稳定型心绞痛而接受成形术）死于冠状动脉夹层。12例（38%）需要立即进行冠状动脉搭桥手术，11例（34%）发生心肌梗死，其中4例梗死范围较小。在随访期间，32例患者中有20例通过药物治疗成功处理；只有2例需要进一步的成形术。无晚期死亡病例。广泛冠状动脉夹层是冠状动脉成形术的严重并发症，早期死亡率高，梗死发生率和搭桥手术需求率高。尽管如此，在手术结束时无急性缺血表现的广泛夹层患者可进行保守治疗，近期和中期预后良好。应尝试在冠状动脉成形术期间稳定广泛夹层，以便在可能的情况下延迟或完全避免手术干预。
