[Occlusion of the common trunk of the left coronary artery. Physiopathological features and clinical findings].
[Occlusion of the common trunk of the left coronary artery. Physiopathological features and clinical findings].
复制标题
[左冠状动脉总干闭塞。
DOI：
--
复制
发表时间：
1986
影响因子：
0.5
通讯作者：
K. Neuhaus
中科院分区：
文献类型：
--
作者：
R. Sciagrà;U. Tebbe;A. Vogt;V. Wiegand;H. Kreuzer;K. Neuhaus
很少观察到左冠状动脉主干完全闭塞（约占冠状动脉造影研究的0.05%）。我们试图从我们的经验和回顾已发表的报告中得出这种情况的临床和病理生理学轮廓。主要由于左主干冠状动脉狭窄患者的高死亡率，难以选择，限制了完全闭塞患者的数量。这些受试者的临床表现存在显著差异。不可能发现与单一风险因素、临床表现或心电图的显著相关性。因此，这些患者无法与其他严重动脉粥样硬化性缺血性心脏病受试者区分开来。冠状动脉造影发现优势右冠状动脉是最常见的。通常可观察到左冠状动脉有丰富的侧支循环。从病理生理学的角度来看，冠状动脉侧支循环的有效性通过其程度与左心室功能的显著相关性来证实。左主干狭窄在完全闭塞中的进展速度和右冠状动脉病变的存在也起着重要作用。即使仍然缺乏统计学证据，手术治疗也是一致的，并取得了令人满意的结果。非手术再通技术的使用，如冠状动脉内溶栓和腔内血管成形术，可能是挽救生命的那些患者中，左主干冠状动脉闭塞突然发生。
The total occlusion of the left main coronary artery is rarely observed (approximately 0.05% of coronary angiographic studies). We have tried to draw the clinical and pathophysiological outline of this condition, starting from our experience and reviewing the published reports. A hard selection, principally by the high mortality in patients with left main coronary stenosis, limits the number of those who present total occlusion. These subjects show a remarkable variability in their clinical presentation. It is not possible to find out a significant correlation with a single risk factor, clinical manifestation or electrocardiographic picture. Therefore, these patients cannot be distinguished from other subjects affected by severe atherosclerotic ischemic heart disease. The angiographic finding of a dominant right coronary artery is most frequent. A rich collateral circulation to the left coronary is usually observed. From a pathophysiological point of view, the efficiency of coronary collateral circulation is confirmed by the significant correlation of its extent with the left ventricular function. An important role is also played by the rate of progression of left main stenosis in total occlusion and by the presence of right coronary lesions. Even if statistical evidence is still lacking, surgical treatment is unanimously indicated and achieves satisfying results. The use of nonsurgical recanalization techniques, such as intracoronary thrombolysis and transluminal angioplasty, may be lifesaving in those patients in whom left main coronary occlusion suddenly occurs.