Nacht C A, Goy J J, Stauffer J C, Vogt P, Essinger A, Kappenberger L
Division de cardiologie, CHU Vaudois, Lausanne, Suisse.
Arch Mal Coeur Vaiss. 1993 Jan;86(1):57-61.
Coronary dissection and acute occlusion are serious complications of coronary angioplasty and may require emergency coronary bypass surgery or result in myocardial infarction or death of the patient. Recently, perfusion balloon catheters allowing prolonged inflations have been used to restore coronary flow after major dissection and occlusion of the artery. Forty-two consecutive patients requiring this procedure were evaluated at short and long term. A satisfactory angiographic result and clinical stabilisation were obtained in 37 cases (88%). Of the 5 immediate failures, 3 (7.1%) underwent coronary bypass surgery and 2 (4.8%) were treated conservatively. Reocclusion was observed in 4 patients (9.5%) during the hospital period; 2 underwent coronary stenting (4.8%) and the other 2 were treated medically. Myocardial infarction was observed in 11 patients (26.2%). Angiographic control was performed 6.2 +/- 3.6 months later in 20 of the 33 patients with no in-hospital complications. Coronary restenosis was observed in 12 of these cases (60%). This study shows the efficacy of perfusion balloon catheter in treating major coronary dissection and coronary occlusion during coronary angioplasty. In particular, the need for emergency coronary bypass surgery was limited. However, there was a high long-term restenosis rate which emphasises the need for careful follow-up of these patients.
冠状动脉夹层和急性闭塞是冠状动脉血管成形术的严重并发症，可能需要紧急冠状动脉搭桥手术，否则可能导致患者心肌梗死或死亡。最近，可长时间充气的灌注球囊导管已被用于在动脉发生严重夹层和闭塞后恢复冠状动脉血流。对连续42例需要进行此操作的患者进行了短期和长期评估。37例（88%）患者获得了满意的血管造影结果并实现了临床稳定。在5例即刻失败的患者中，3例（7.1%）接受了冠状动脉搭桥手术，2例（4.8%）接受了保守治疗。在住院期间，4例患者（9.5%）出现再闭塞；2例接受了冠状动脉支架置入术（4.8%），另外2例接受了药物治疗。11例患者（26.2%）发生心肌梗死。在33例无住院并发症的患者中，20例在6.2±3.6个月后进行了血管造影复查。其中12例（60%）出现冠状动脉再狭窄。本研究显示了灌注球囊导管在治疗冠状动脉血管成形术期间的严重冠状动脉夹层和冠状动脉闭塞方面的疗效。特别是，紧急冠状动脉搭桥手术的需求有限。然而，长期再狭窄率较高，这强调了对这些患者进行密切随访的必要性。
