nmpЖурнал им. Н.В. Склифосовского «Неотложная медицинская помощь»Russian Sklifosovsky Journal "Emergency Medical Care"2223-90222541-8017“N.V. Sklifosovsky Research Institute for Emergency Medicine”nmp-185Research ArticleПРАКТИКА ОКАЗАНИЯ НЕОТЛОЖНОЙ МЕДИЦИНСКОЙ ПОМОЩИPRACTICE OF EMERGENCY MEDICAL CAREСОВРЕМЕННЫЕ ПОДХОДЫ К ПРОФИЛАКТИКЕ, ОЦЕНКЕ И ЛЕЧЕНИЮ ОСЛОЖНЕНИЙ ЭНДОВАСКУЛЯРНЫХ ВМЕШАТЕЛЬСТВ НА КОРОНАРНЫХ АРТЕРИЯХ. ЧАСТЬ I. РАЗРЫВЫ КОРОНАРНЫХ АРТЕРИЙCURRENT APPROACHES TO THE PREVENTION, EVALUATION AND TREATMENT OF COMPLICATIONS DURING ENDOVASCULAR CORONARY ARTERY INTERVENTIONS. PART I. CORONARY ARTERY RUPTURESПрозоровС. А.ProzorovS. A.

д.м.н., ведущий научный сотрудник отделения рентгенохирургических методов диагностики и лечения

surgeonserge@mail.ruНИИ скорой помощи им. Н.В. Склифосовского ДЗ г. Москвы, МоскваРоссияSklifosovsky Research Institute for Emergency Medicine, MoscowRussian Federation201402042016022631Copyright © Прозоров С.А., 20162016Прозоров С.А.Prozorov S.A.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.jnmp.ru/jour/article/view/185ЦЕЛЬ ИССЛЕДОВАНИЯ

ЦЕЛЬ ИССЛЕДОВАНИЯ. Цель — анализ частоты, причин, предикторов, форм разрывов коронарных артерий при эндоваскулярных вмешательствах и современных подходов к их лечению.

МАТЕРИАЛ И МЕТОДЫ

МАТЕРИАЛ И МЕТОДЫ. Проанализированы результаты вмешательств у 2317 больных с января 2010 по март 2013 г. Разрывы коронарных артерий были у 5 пациентов (0,22%).

РЕЗУЛЬТАТЫ

РЕЗУЛЬТАТЫ. Разрыв коронарной артерии II типа по S.G. Ellis произошел у одного больного, а III типа — у 4 паци- ентов. У одного больного стенка была перфорирована гидрофильным проводником, у 2 — разрыв возник при баллонной дилатации и у 2 — при постдилатации после имплантации стента. Использованы методы лечения осложнения: длительное раздувание баллона, имплантация стент-графтов, эмболизация. Они оказались эффективны в 4 случаях из 5, в одном случае при имплантации стент-графта произошел повторный разрыв сосуда со смертельным исходом.

ВЫВОДЫ

ВЫВОДЫ. В зависимости от причины и формы разрыва коронарной артерии должны быть использованы разные методы для ликвидации разрыва, возможно успешное лечение этого осложнения. 

AIM OF THE STUDY

AIM OF THE STUDY. The aim of the study was to investigate the incidence, causes, predictors, forms of coronary artery ruptures during endovascular interventions, and to present current approaches to rupture treatment.

MATERIAL AND METHODS

MATERIAL AND METHODS. The results of endovascular procedures performed in 2317 patients from January 2010 to March 2013 were reviewed. Coronary artery ruptures occurred in 5 patients (0.22%).

RESULTS

RESULTS. A coronary artery rupture was classified by Ellis criteria as type II in 1 patient and as type III in 4 patients. The vessel wall was perforated with a hydrophilic guidewire in one patient. A rupture occurred during balloon dilatation in 2 patients, and at postdilatation after stent implantation in 2 other patients. The complications were treated using the following techniques: a prolonged balloon inflation, implantation of stent-grafts, embolization. These approaches proved to be effective in 4 of 5 cases, in 1 case a repeated rupture during the stent-graft implantation resulted in a fatal outcome.

CONCLUSIONS

CONCLUSIONS. The treatment techniques for coronary artery ruptures may be different and the choice should be based on the cause and the form of rupture. Successful treatment of this complication is feasible. 

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The authors declare that there are no conflicts of interest present.