Pessanha A V, Rodrigues C, Fuks V, Murad H, Murad M
Hospital São Vicente de Paula, Rio de Janeiro.
Arq Bras Cardiol. 1997 Mar;68(3):193-7.
We describe a case of coronary stenosis located in an unprotected left main coronary artery, treated primarily and electively with the placement of a coronary stent. As a function of the large mass of myocardium involved, this patient would be considered a classical candidate for direct surgery, because the inherent risk involved with conventional balloon angioplasty, mainly due to the eventual occurrence of acute closure during the procedure. Since the previsibility of the immediate results with the use of coronary stents was significantly improved, we propose this new therapeutic approach for this traditionally surgical case, that has been performed with success and without any complication. This strategy for the treatment of unprotected left main lesions with the elective placement of Palmaz-Schatz stents, has not yet been proposed or applied in our country, and may represent a new universe of indication of percutaneous treatment of coronary artery disease, no longer approaching the left main stem only in special or emergency situations, usually a result of complications of left main manipulation during angioplasty of the coronary system. The patient involved in this case did not show any contraindication for the treatment with conventional open heart surgery.
我们描述了一例位于无保护左主干冠状动脉的狭窄病例，主要通过选择性植入冠状动脉支架进行治疗。鉴于受累心肌范围较大，该患者被视为直接手术的典型候选者，因为传统球囊血管成形术存在固有风险，主要是由于术中可能最终发生急性闭塞。由于使用冠状动脉支架后即刻结果的可预测性显著提高，我们针对这一传统上需手术治疗的病例提出了这种新的治疗方法，该方法已成功实施且无任何并发症。这种通过选择性植入帕尔马兹 - 施茨支架治疗无保护左主干病变的策略，在我国尚未被提出或应用，可能代表了冠状动脉疾病经皮治疗的新适应症领域，不再仅在特殊或紧急情况下（通常是冠状动脉系统血管成形术期间左主干操作并发症的结果）才处理左主干。该病例中的患者未显示出任何常规心脏直视手术治疗的禁忌症。
