应用支架术成功开通1例左锁骨下动脉慢性完全性闭塞8a病变临床分析

目的探讨锁骨下动脉慢性完全性闭塞(CTO)病程8 a的病变经皮腔内血管成形术(PTA)开通和成功植入支架的方法及效果.方法对头晕、头痛、左上肢无脉伴左上肢冷感、麻木、酸痛和活动时加重持续8 a的患者经左锁骨下动脉造影证实为左锁骨下动脉CTO病变的病例行支架术治疗.经右股动脉入路,置入8F指引导管,应用冠状动脉介入导丝PROGRESS,在小球囊(1.5 mm×15 mm)的支撑下通过病变到达左锁骨下动脉远端.应用1.5 mm×20 mm、2.0 mm×20 mm和4.0 mm×1 5 mm Maverick冠脉球囊12~16 atm×30 s依次预扩张病变全程,植入6.0 mm×57 mm Express支架.结果支架植入后,病变血管恢复血流TIMIⅢ级,桡动脉波动有力,患肢血压恢复正常,患者症状消失.结论 PTA和支架术是持久开通锁骨下动脉闭塞的有效方法,且操作简便,安全,近期和远期效果好.

Clinical Analysis on Successful Recanalization of One Case with Chronic Total Occlusions of Left Subclavian Artery Treated with Stent

Objective To explore the method and effects on successful recanalization of subclavian artery chronic total occlusions ( CTO ) lesions lasting for pathological course of eight years treated with percutaneous transluminal angioplasty( PTA) and stent implantation. Method The patients suffered from dizziness,headache and ischemic symptoms of left upper limb( cold feeling,numbness,pain,and activities increase) for eight years, and were proved to be CTO of the left subclavian artery by angiography and underwent stent implantation. The right femoral approach was used in the procedures. 8F guide catheter and PROGRESS guidewire ( coronary guidewire) were inserted into the ostium of left subclavian artery. With the support of the small balloon( diameter and length were 1. 5 mm×15 mm),the guidewire passed hard through the occluded lesions to distal vessel. Then the perdilatation for the entire lesions was performed with 1. 5 mm×20 mm,2. 0 mm×20 mm and 4. 0 mm×15 mm Maverick balloon with 12~16 atm for 30 seconds separately. Express stent(6. 0 mm×57 mm,Balloon expandable stent) was implanted with 16 atm × 30 seconds. Results After stenting, blood flow in the lesion blood vessel recovered to TIMI Ⅲ level, left radial artery fluctuations were clear, blood pressure of the left supper limb returned to normal,and the symptoms of ischemia disappeared. Conclusion PTA and stenting are effective and safe method for the persistent recanalization of subclavian artery CTO lesions, easy to operate, and have good immediate and long-term effects.