【摘要】 目的:探讨经冠状动脉射频消融(TCRAF)联合支架植入同期治疗先天性冠状动脉瘘(CCAF)合并冠状动脉狭窄(CAS)的安全性和疗效。方法:纳入2022年11月—2025年5月在贵州省人民医院因不稳定性心绞痛住院，确诊为CCAF合并严重CAS,并接受TCRFA联合支架植入治疗的患者10例。收集全部患者临床资料、介入治疗过程、术后即刻结果及术后随访资料，对该术式的安全性、有效性进行初步分析。结果:冠状动脉造影发现10例患者共存在24支瘘血管，分别起源于左前降支(LAD)12支(50%)、右冠状动脉(RCA)9支(37.5%)、左主干(LM)2支(8.3%)及回旋支(LCX)1支(4.2%),均分流至肺动脉。冠状动脉狭窄单支病变7例、双支病变2例、3支病变1例。采用TCRFA共封堵起源狭窄病变冠状动脉的瘘血管16支。术后即刻造影显示，15支瘘血管完全闭合，1支瘘血管次全闭塞。共对14处严重狭窄病变植入药物洗脱支架22枚。术中未出现冠状动脉穿孔、急性支架内血栓、致死性心律失常等严重并发症。术后中位随访时间为9个月，所有患者症状均显著缓解。术后3个月无主要不良心血管事件，生存率为100%。术后9～12个月复查的冠状动脉造影仅发现1支瘘血管出现再通，所有支架内均未见明显再狭窄。结论:TCRFA联合药物洗脱支架植入同期一站式介入治疗CCAF合并CAS是一种安全可行、有效且微创的治疗策略。更多还原

【Abstract】 Objective: To investigate the safety and efficacy of transcoronary radiofrequency ablation(TCRFA) with concomitant stenting for congenital coronary artery fistula(CCAF) complicated by coronary artery stenosis(CAS). Methods: Ten patients, hospitalized at Guizhou Provincial People’s Hospital from November 2022 to May 2025 for unstable angina, diagnosed with CCAF complicated by severe CAS and treated with TCRFA combined with stenting, were enrolled. Clinical data, interventional procedures, immediate postoperative outcomes, and follow-up information were collected for preliminary analysis of the procedure’s safety and efficacy. Results: Coronary angiography revealed 24 fistulas, draining from the left anterior descending artery(LAD) in 12 patients(50%), from the right coronary artery(RCA) in 9(37.5%), from the left main coronary artery(LM) in 2(8.3%), and from the left circumflex artery(LCX) in 1(4.2%). All fistula vessels drained into the pulmonary artery. Seven patients presented single-vessel coronary artery stenosis, two presented two-vessel disease, and one presented three-vessel disease. Sixteen fistulas, originating from the coronary arteries with stenotic lesions, were occluded by TCRFA. Immediate postprocedure angiography demonstrated complete occlusion in 15 fistulas and near-complete occlusion of 1 fistula. Subsequently, a total of 22 drug-eluting stents were implanted at 14 stenotic lesions without major complications, including coronary artery perforation, acute in-stent thrombosis, or life-threatening arrhythmias. At median a follow-up of 9 months, all patients experienced significant symptom relief. The 3-month major adverse cardiovascular event-free survival rate was 100%. Repeated coronary angiography revealed only one recanalized fistula and no in-stent restenosis after 9-12 months. Conclusion: Combined TCRFA and drug-eluting stenting as one-stop interventional treatment for CCAF with CAS is a safe, feasible, effective, and minimally invasive therapeutic strategy.更多还原