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題名 | Elective Coronary Stenting for Unprotected Left Main Stenosis--A Case Report=對高危險性左主冠狀動脈病變而無保護血管之病患施以例行性冠狀動脈血管內支架治療--一病例報告 |
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作者 | 羅鴻舜; 陳逸忠; 鄭仁露; | 書刊名 | Acta Cardiologica Sinica |
卷期 | 13:3 民86.07-09 |
頁次 | 頁157-162 |
分類號 | 415.384 |
關鍵詞 | 左主冠狀動脈病變; 經皮冠狀動脈擴張術; 冠狀動脈血管內支架; Left main coronary artery; Percutaneous transluminal coronary angioplasty; Coronary artery stenting; |
語文 | 英文(English) |
中文摘要 | 背景:左主冠狀動脈之病變,實施血管擴張術,具有極大的立即性及長期性的死亡率及罹病率。因此冠狀動脈繞道手術仍然是左主冠狀動脈之病變,特別是未保護性者之治療準則。 不管血管擴張術之儀器與手術者之技術如何地增進,以及對左主冠狀動脈病變之獨特機轉更加瞭解,經皮冠狀動脈擴張術仍只適應於有保護性的左主冠狀動脈病變者,或未保護性的左主冠狀動脈病變,但是具有極高的繞道手術危險性者,或當左主冠狀動脈面臨急性阻塞之危機時,充當疏困之用者。 方法與結果:在此我們報告一例曾經作過繞道手術的七十五歲男性,其患有左主冠狀動脈病變,且同時併有左前下降枝及左迴旋枝之病變。因其接受再度繞道手術之危險性極高,我們成功地完成冠狀動脈血管內支架手術。這病人在住院期間,乃至出院後五個月之追蹤期間,不復有胸痛之情形發生。 結論:當左主冠狀動脈面臨急性阻塞之危機,或未保護性的左主冠狀動脈病變,但是具有極高的繞道手術危險性者,不妨考慮以冠狀動脈血管內支架治療。 |
英文摘要 | Background. Percutaneous transluminal coronary angioplasty (PTCA) of the left main coronary artery (LMCA) carries relatively high rates of immediate and long-term mortality and morbidity. Despite improvement in operating skills, angioplasty material and a better understanding of the underlying pathological process, PTCA is indicated only in the protected LMCA lesion, or in the unprotected LMCA lesion where the patient is at very high risk for surgery or has an acute/threatened occlusion of the LMCA. Coronary artery bypass graft (CABG) surgery remains the treatment of choice in patients with unprotected LMCA disease. Methods and Results. Herein is a report of a 75-year-old man with critical LMCA disease involving left anterior descending (LAD) artery or left circumflex (LCX) artery, who electively underwent a successful coronary stenting of an unprotected LMCA because of an extraordinary high risk for repeat CABG. The patient's hospital stay was uneventful and he remained symptom-free at five-month clinical follow-up. Conclusions. Coronary stenting may be considered in some selected cases with unprotected left main stenosis in emergency situations, or in elective cases with excessive risk for bypass surgery. |
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