摘要
目的冠状动脉内血栓是影响急性心肌梗死(AMI)介入治疗效果的重要因素,本研究通过冠状动脉内血栓抽吸,并联合球囊成型及支架植入术治疗AMI,评价其安全性、有效性。方法进行急诊PCI的AMI患者共52例,对其中20例进行冠状动脉内血栓抽吸,然后进行球囊扩张及支架植入治疗。术后造影观察冠状动脉扩张效果及梗死相关血管血流及心肌灌注等情况。结果抽吸组即刻血栓消失16例,血栓减少4例。和未抽吸组比较梗死部位前向血流由术前TI-MI 0级(无血流)均达到TIMI 3级(正常血流),术中及术后无严重并发症。而未抽吸组术后前向血流TIMI 1级(血流严重受损)1例(占3.1%),2级(正常血流但较慢)9例(占28.1%),3级22例(占68.8%),二者有明显差异(P<0.05)。结论经导管进行冠状动脉内血栓抽吸,是治疗冠状动脉狭窄合并血栓病变的简单有效的方法,并可提高经皮冠状动脉介入治疗的成功率及减少无再流等并发症的发生。
Objective To determine whether aspiration of thrombotic material before stent implantation of the infarct-related coronary artery results in improved myocardial perfusion compared with conventional primary percutaneous coronary intervention （PCI）. Methods Fifty-two patients with acute myocardial infarction were divided into two groups： 32 patients who underwent intervention without a thrombus aspiration device and 20 patients who were treated as soon as a specifically designed thrombus aspiration catheter became available at our institution. All patients will be treated medically according to current international guidelines including glycoprotein Ⅱb/Ⅲa inhibitors before PCI. Randomization will be performed before coronary angiography. Results The flow was improved in the thrombus aspiration group from TIMI 0 （18 patients, no flow） or TIMI 1 （2 patients, impaired flow） to TIMI 3 （20 patients, 100%, normal flow） without severe complication. In the control group, the flow was improved from TIMI 0 （37 patients） or TIMI 1 （5 patients） to TIMI 3 （22 patients, 68.8%）, TIMI 2 （9 patients, 28.1%, normal but slower flow） and TIMI 1 （1 patient, 3.1%）, respectively. Thrombus was disappeared in 16 patients （80%） and less thrombus was seen in 4 patients （20%） immediately after thrombus aspiration procedure. Conclusion This randomized study shows that manual thrombus-aspiration in unselected patients with undergoing primary PCI is clinically feasible and results in better angiographic and ECG myocardial reperfusion rates compared with those achieved by standard PCI.
出处
《中国介入影像与治疗学》
CSCD
2006年第6期406-409,共4页
Chinese Journal of Interventional Imaging and Therapy
关键词
血栓抽吸
经皮冠状动脉介入
心肌梗塞
Thrombus aspiration
Percutaneous coronary intervention, Myocardial infarction
