复杂病例的经皮冠状动脉腔内成形术

1988年元月至1997年10月我院完成的复杂经皮冠状动脉腔内成形术（Percutaneoustransluminalcoronaryangioplasty,PTCA）74例，占同期PTCA总例数的49．3％，其中年龄大于或等于70岁者10例，不稳定心绞病34例，左心室射血分数小于40％者6例；48例为多支血管病变。PTCA共扩张85在血管，靶病变93处，A型病变15处，B型病变53处，C型病变25处。7例采用灌注球导管，28例植入冠状动脉内支采，1例行冠状动脉内膜定向切除术。PTCA病倒成功率93．2％，病变成功率90．3％，本前平均狭窄（89．5±82）％，术后平均狭窄（16．9±6．2）％．死亡2例，无息性心肌梗塞和急诊冠状动脉搭桥者。讨论了复杂病例PTCA的成功率、可能出现的风险及处理对策，表明复杂病例PTCA仍可取得较好临床效果。

HIGH-RISK" PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY

Percutaneous translumianal coronary angioplasty (PTCA) was performed in 74 patients with high risk characteristics from Jan. 1988to Oct. 1997. These factors include age>70 years(n = 10), unstable ungina (n = 34), ejection fraction<40% (n = 6), multivessel disease (n = 48).There were 93 lesions (85 vessels) dilated,amongthem type A lesion n = 15,type B lesion n= 53 andtype C lesion n = 25. Autoperfusion balloon wasused in 7 patients and coronary stent was implantedin 28 patients. One patient was performed by directional coronary athrectomy (DCA ). The resultsshowed that the clinical successful rate was 93. 2%and lesion successful rate wes 90. 3%. In addition,the average predication stenosis was (89. 5±8. 2) %and average POstdilation stenosis was (16. 9± 6. 2)%. Two patients died due to abrupt vesselclosure, but no acute myocardial infarction and emergency coronary bypass operation. The considerations in selection and management of these highrisk patients were also discussed in this paper. Ourstudy suggested that PTCA can be Performed safelyin patients with these high risk features.