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多支弥漫性病变植入TAXUS 支架病例(图)

2015-12-02 网络 MedSci原创

阜外心血管病医院 术者:乔树宾 病例描述: 即往病史: 患者,男,53岁。劳力型心绞痛2个月。无心肌梗死历史。危险因素包括:高血压病史。左室各节段室壁运动正常,LVEF=88.4%(LV Angiogram)。术前血管造影情况: LM正常;LAD40%狭窄;LCx中段90%狭窄,OM80-90%管状狭窄;RCA弯曲,第一转折后弥漫性,最重90%。手术过程: 经右桡动脉穿刺,送入6F鞘,

阜外心血管病医院

术者:乔树宾

病例描述:

即往病史:

患者,男,53岁。劳力型心绞痛2个月。无心肌梗死历史。危险因素包括:高血压病史。左室各节段室壁运动正常,LVEF=88.4%(LV Angiogram)。术前血管造影情况:

LM正常;LAD40%狭窄;LCx中段90%狭窄,OM80-90%管状狭窄;RCA弯曲,第一转折后弥漫性,最重90%。手术过程:

经右桡动脉穿刺,送入6F鞘,选用6F JFL引导导管送至LM开口,将0.014"引导钢丝送入OM远端,用2.5/20mm球囊反复扩张该弥漫性病变4次,最大压力12atm,最长时间25sec后,选用3.0/28mmTAXUS支架覆盖LCx中段和OM两处病变,以11atm×25sec一次扩张成功。

考虑到RCA非常弯曲,治疗中远段弥漫性病变需用具有很好支撑力的引导导管,选用6F XBRCA,将0.014"引导钢丝送入RCA远端,用2.5/20mm球囊以8atm×30sec扩张RCA远段病变后,以12atm×30sec植入3.0/28mmTAXUS支架;近段直接植入3.5/16mmTAXUS支架,以12atm×35sec扩张成功。术后结果/结论:

术后LCx-OM和RCA病变处无残余狭窄,TIMI三级血流,无内膜撕裂和血栓形成征象。该患者术后3天出院,术后2个月内临床随访无事件发生。

器械:LCx-OM:

6F Brite Tip JFL Guiding Catheter (Cordis)

HT BMW 0.014'×190cm Wire (Guidant)

U-Pass 2.5×20mm Balloon (Cordis)

TAXUS (Paclitaxel-eluting stent) 3.0×28mm (Boston Scientific)

RCA:

6F Brite Tip XBRCA Guiding Catheter (Cordis)

HT BMW 0.014'×190cm Wire (Guidant)

U-Pass 2.5×20mm Balloon (Cordis)

TAXUS (Paclitaxel-eluting stent) 3.0×28mm (Boston Scientific)

TAXUS (Paclitaxel-eluting stent) 3.5×16mm (Boston Scientific)




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