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- 周忠江副主任医师
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医院:
南方医科大学南方医院
科室:
心血管内科
- 疯狂的美国医生
- 作者:周忠江|发布时间:2010-11-14|浏览量:669次
今天在翻阅JACC杂志时看到了如下这篇文章:
A Heart With 67 Stents
Rami N. Khouzam, MD, Rajvir Dahiya, MD, Richard Schwartz, MD
Mineola, New York
A56-year-old male with coronary artery disease presented with angina, nonspecific electrocardiographi changes, and elevated troponins. Coronary angiography revealed total occlusion of a stent in the circumflex artery, where another was deployed?his 67th stent. The patient had 28 catheterizations over 10 years, with stents placed in his native coronary arteries as well as in 3 bypass grafts. All stents were placed to relieve his angina, refractory to maximal medical treatment and transmyocardial laser revascularization. Stents can be a great tool to help revascularization and relieve symptoms; unfortunately, they are prone to thrombosis南方医科大学南方医院心血管内科周忠江
and restenosis. If they fail while medical management is maximized unsuccessfully, alternative tools are lacking. This case raises many questions: “How much is too much?” “Are there guidelines?” and “What else can be offered for symptom relief?” More studies are needed to evaluate impact on quality of life versus risks in this multistent population. LAD left anterior descending coronary artery; LCX left circumflex coronary artery; OM obtuse marginal branch of the circumflex coronary artery; RCA right coronary artery.
Journal of the American College of Cardiology, Volume 56, Issue 19, 2 November 2010, Page 1605
简单翻译如下:一个56岁的男性冠心病患者,因心绞痛而入院,随访心电图无明显变化、肌钙蛋白升高。冠脉造影显示一个回旋支支架内完全闭塞,同时冠脉造影时还看到了这个病人之前已经植入的另外67个支架。在过去的10余年间,该患者共接受了28次冠脉造影检查,先后于所有的冠状动脉及3支桥血管内植入支架。所有的支架的植入均是为了缓解药物治疗欠佳的难治性心绞痛症状。在开通血管及缓解心绞痛症状方面,冠脉支架植入是一项很有效的治疗措施,但是,他们同时也带来了支架内血栓形成、再狭窄等问题。如果支架治疗效果欠佳,则其他治疗措施就比较缺乏了。这个病例让我们思考很多的问题:在支架植入方面,多少才算是多呢?有没有这方面的指南呢?在缓解心绞痛症状方面,除了支架植入,还有没有其他的措施呢?需要更多的研究来评价多支架植入病人的生活质量及危险因素。
A Heart With 67 Stents
Rami N. Khouzam, MD, Rajvir Dahiya, MD, Richard Schwartz, MD
Mineola, New York
A56-year-old male with coronary artery disease presented with angina, nonspecific electrocardiographi changes, and elevated troponins. Coronary angiography revealed total occlusion of a stent in the circumflex artery, where another was deployed?his 67th stent. The patient had 28 catheterizations over 10 years, with stents placed in his native coronary arteries as well as in 3 bypass grafts. All stents were placed to relieve his angina, refractory to maximal medical treatment and transmyocardial laser revascularization. Stents can be a great tool to help revascularization and relieve symptoms; unfortunately, they are prone to thrombosis南方医科大学南方医院心血管内科周忠江
and restenosis. If they fail while medical management is maximized unsuccessfully, alternative tools are lacking. This case raises many questions: “How much is too much?” “Are there guidelines?” and “What else can be offered for symptom relief?” More studies are needed to evaluate impact on quality of life versus risks in this multistent population. LAD left anterior descending coronary artery; LCX left circumflex coronary artery; OM obtuse marginal branch of the circumflex coronary artery; RCA right coronary artery.
Journal of the American College of Cardiology, Volume 56, Issue 19, 2 November 2010, Page 1605
简单翻译如下:一个56岁的男性冠心病患者,因心绞痛而入院,随访心电图无明显变化、肌钙蛋白升高。冠脉造影显示一个回旋支支架内完全闭塞,同时冠脉造影时还看到了这个病人之前已经植入的另外67个支架。在过去的10余年间,该患者共接受了28次冠脉造影检查,先后于所有的冠状动脉及3支桥血管内植入支架。所有的支架的植入均是为了缓解药物治疗欠佳的难治性心绞痛症状。在开通血管及缓解心绞痛症状方面,冠脉支架植入是一项很有效的治疗措施,但是,他们同时也带来了支架内血栓形成、再狭窄等问题。如果支架治疗效果欠佳,则其他治疗措施就比较缺乏了。这个病例让我们思考很多的问题:在支架植入方面,多少才算是多呢?有没有这方面的指南呢?在缓解心绞痛症状方面,除了支架植入,还有没有其他的措施呢?需要更多的研究来评价多支架植入病人的生活质量及危险因素。