Simultaneous Successful Recanalization of Two Chronically Occluded Coronary Arteries in a Patient: A Case Report

同時再通暢治療一病患之兩條慢性完全阻塞冠狀動脈－病歷報告

邱俊仁(Chiung-Zuan Chiu) ； 程俊傑(Jun-Jack Cheng)

《輔仁醫學期刊》 6卷2期 (2008/06) Pp. 93-98

摘要

成功再通暢治療慢性完全阻塞冠狀動脈至今仍為介入性心臟科醫師技術上最大之挑戰。而同時再通暢治療一病患之兩條慢性完全阻塞冠狀動脈為一更困難之技術且以往並未有其它文獻報導過。
我們報告一49歲男性於胸痛後5個月接受冠狀動脈造影。冠狀動脈造影顯示左前降支及左迴旋支動脈完全阻塞，同時有明顯之側支循環(bridging collaterals)從右冠狀動脈至左冠狀動脈。病人拒絕冠狀動脈繞道手術而接受經皮冠狀動脈介入性治療。兩條慢性完全阻塞冠狀動脈於一次冠狀動脈介入性治療中成功同時再暢通，並置入五支塗藥支架。本篇報告主要討論治療慢性完全阻塞冠狀動脈之策略及益處。同時亦討論塗藥支架用於減少慢性完全阻塞冠狀動脈再通暢治療後之再狹窄率。

關鍵字

經皮冠狀動脈介入性治療 ； 慢性完全冠狀動脈阻塞 ； 側支循環 ； 塗藥支架

並列摘要

Percutaneous coronary intervention (PCI) for chronically occluded coronary arteries remains the greatest technical challenge for interventional cardiologists. The successful simultaneous recanalization of 2 chronically occluded coronary arteries in a patient is a more-challenging and difficult technique and has not previously been reported.
We report a 49-year-old man who underwent coronary angiograms 6 months after developing typical effort angina. Coronary angiograms revealed chronic total occlusion (CTO) of the left anterior descending artery and left circumflex artery with evident bridging collaterals from the right coronary artery. The patient refused coronary bypass surgery and underwent PCI for the CTO lesions. Two CTO arteries were simultaneously recanalized without complications, and 5 drug-eluting stents (DESs) were deployed. In the present case report, we discuss the strategies and benefits of recanalization of CTO coronary lesions and the role of DESs in reducing the restenosis rate after recanalization for CTO.

並列關鍵字

percutaneous coronary intervention ； chronic total occlusion ； bridging collaterals ； drug-eluting stent