冠状动脉瘤的诊断学特征及明胶海绵颗粒栓塞治疗的疗效分析

doi:10.3877/cma.j.issn.2095-655X.2022.02.005

目的

探讨冠状动脉瘤的诊断学特征及明胶海绵颗粒栓塞治疗的疗效分析。

方法

回顾性分析2020年3月4日济宁医学院附属医院心血管内科收治的1例冠心病(冠状动脉支架植入术后)合并冠状动脉瘤患者的临床资料，总结并分析冠状动脉瘤的诊断学特征及明胶海绵颗粒栓塞治疗的疗效。

结果

患者56岁，女性，因"发作性胸痛6年余，加重6 d"入院，既往已行经皮冠状动脉介入治疗；患者入院前6 d，体力活动时再次出现胸痛，呈胸骨后闷痛，每次持续5~6 min，伴后背部放射痛、出汗，活动量大时症状明显，休息数分钟可缓解，考虑急性冠脉综合征，行冠状动脉造影发现第一对角支内的支架次全闭塞，支架近段冠状动脉瘤形成，呈囊状，大小约0.67 cm×0.42 cm，予明胶海绵颗粒栓塞治疗冠状动脉瘤，治疗效果尚可。

结论

诊断和评估冠状动脉瘤的"金标准"是冠状动脉造影。采用明胶海绵颗粒栓塞治疗冠状动脉瘤具有一定的启示意义。

关键词: 冠状动脉瘤, 冠状动脉造影, 明胶海绵颗粒, 栓塞, 诊断

Objective

To investigate the diagnostic characteristics of coronary artery aneurysms (CAA) and analysis of the effect of embolization with gelatin sponge particles in the treatment of CAA.

Methods

The clinical data of a patient with coronary artery disease (post-coronary stent implantation) and CAA admitted to the Cardiology Department, Affiliated Hospital of Jining Medical University on March 4, 2020 was retrospectively analyzed, and the diagnostic features of CAA and the efficacy of embolization with gelatin sponge particles were summarized and analyzed.

Results

A 56-year-old female who was admitted to the hospital for " paroxysmal chest pain for more than 6 years, exacerbated for 6 days" . The patient had previously undergone percutaneous coronary intervention. Six days before admission, the patient manifested chest pain recurring during physical activity, which was a dull pain behind the breastbone lasting for 5-6 minutes each episode, accompanied by back radiating pain and sweating. Symptoms were obvious when the amount of activity was large and could be relieved by a few minutes of rest. The acute coronary syndrome was proposedly diagnosed. The patient′s coronary angiography revealed subtotal occlusion of the stent in the first diagonal branch, and a 0.67 cm×0.42 cm sachike CAA was formed near the stent. Embolization of coronary aneurysm with gelatin sponge particles had a satisfactory therapeutic effect.

Conclusions

The " gold standard" for diagnosing and evaluating CAA is coronary angiography. Embolization with gelatine sponge particles for CAA has certain enlightening significance.

Key words: Coronary artery aneurysm, Coronary angiography, Gelatin sponge particles, Embolism, Diagnosis

图1 冠状动脉瘤患者入院后3 d冠状动脉造影图像注：D1支架近端可见CAA，呈囊状，大小约0.67 cm×0.42 cm(以图中*所示的5F共用冠状动脉造影管为参照，直径约0.17 cm)(箭头所示)；LAD为左前降支；D1为第1对角支；LCX为左回旋支；CAA为冠状动脉瘤

图2 冠状动脉瘤患者入院后6 d明胶海绵颗粒栓塞治疗后的冠状动脉造影图像注：可见明胶海绵颗粒栓塞治疗后，CAA消失，D1无显影，LAD及LCX未受影响；LAD为左前降支；D1为第1对角支；LCX为左回旋支；CAA为冠状动脉瘤

图3 冠状动脉瘤患者明胶海绵颗粒治疗后7个月冠状动脉造影复查图像注：可见D1自开口闭塞，中段可见支架影，未见CAA显影，前向血流TIMI 0级；LAD为左前降支；D1为第1对角支；LCX为左回旋支；CAA为冠状动脉瘤

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Diagnostic features of coronary artery aneurysm and analysis of the curative effect of embolization with gelatin sponge particles

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Diagnostic features of coronary artery aneurysm and analysis of the curative effect of embolization with gelatin sponge particles