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目的 :评价冠状动脉 (冠脉 )内支架置入术治疗有心肌缺血症状心肌桥的可行性及疗效。方法 :共选择 10例有明显心肌缺血表现的心肌桥患者行支架置入术治疗。冠脉造影示心肌桥均位于前降支 ,心脏收缩时壁冠脉狭窄率 75 %～ 10 0 % ,狭窄长度 8～ 2 0mm。 8例置入Penta支架 ,2例置入CypherTM 支架。结果 :支架置入术的成功率为 10 0 % ,支架置入后即刻冠脉造影显示心肌桥压迫影像消失。术中有 1例发生了壁冠脉穿孔 ,后经球囊原位长时间低压力扩张封堵破孔终止了局部出血。术后所有患者的心绞痛症状均明显减轻或完全消失。在 4～ 13个月的随访期间 ,有 3例置入Penta支架的患者再发心绞痛 ,其中 1例作了重复冠脉造影 ,证实其支架内发生了 95 %的再狭窄。 2例置入了CypherTM支架的患者一直无症状 ,其中 1例复查了冠脉造影并获得了非常满意的造影结果。结论 :对有症状的心肌桥患者冠脉内支架置入术是可选的治疗方法 ,尤其对药物治疗无效或有禁忌的患者更为适用。支架术的近期疗效非常满意 ;远期效果不太理想 ,使用CypherTM支架有可能使此结果得到明显改善。由于支架置入术有引起壁冠脉破裂穿孔的危险 ,术前应权衡利弊 ,严格选择病例。
Objective: To evaluate the feasibility and efficacy of intracoronary (coronary) stenting in the treatment of myocardial bridge with myocardial ischemia. Methods: A total of 10 cases of myocardial bridge with obvious myocardial ischemia were treated with stenting. Coronary angiogram showed myocardial bridge are located in the anterior descending branch, myocardial stenosis wall stenosis rate of 75% to 100%, stenosis length 8 ~ 20mm. Eight patients were placed in the Penta stent and two patients were placed in the Cypher stent. Results: The success rate of stenting was 100%. Coronary angiography immediately after stenting showed disappearance of myocardial bridge compression. Intraoperative coronary artery perforation occurred in 1 case, after a long period of low pressure by the balloon in situ expansion of the closure of the hole to terminate the local bleeding. All postoperative angina symptoms were significantly reduced or completely disappeared. During 4 to 13 months of follow-up, 3 patients who had Penta stents had angina recurrence, 1 of whom underwent repeat coronary angiography and confirmed 95% restenosis within the stent. Two patients who had Cypher stents were asymptomatic, one of whom underwent coronary angiography and had a very satisfactory radiographic result. CONCLUSIONS: Coronary stent placement in patients with symptomatic myocardial bridges is an option for treatment, especially in patients who are ineffective or contraindicated. The immediate effect of stenting is very satisfactory; the long-term effect is less than ideal, and the use of the Cypher stent may significantly improve the result. As stenting has caused the risk of perforation of the wall coronary artery rupture, the pros and cons should be weighed before surgery, the strict selection of cases.