中文摘要：

目的 分析植入覆膜支架的Ⅲ型冠状动脉穿孔的分布特征、原因及效果。 方法 回顾性分析有记录的植入覆膜支架的Ⅲ型冠脉穿孔病例。结果 冠状动脉穿孔植入覆膜支架28（男20，女8）例，年龄45～85（66±8）岁；穿孔血管分别为前降支20例（71%），右冠状动脉6例（21%），回旋支2例（7%）；穿孔部位血管病变分型分别为A型病变16例（57%），C型病11例（39%），B2型病变1例（4%）,CTO 6例（21%），严重钙化病变10例（36%），心肌桥3例（11%）；穿孔的原因分别为支架球囊后扩张15例（54%），支架释放6例（21%），后扩张球囊后扩张3例（11%），预扩张球囊扩张1例（4%），导丝3例（11%）。穿孔后有17例（61%）发生心包填塞。24例（86%）植入覆膜支架的患者封堵成功，6例患者紧急外科开胸探查，其中4例行急诊冠状动脉旁路移植术。住院期间死亡3例（11%），术中和住院期间发生主要心血管不良事件的患者9例（32%）。有7例患者进行了造影随访，70%以上的狭窄有3例。结论 植入覆膜支架的Ⅲ型冠状动脉穿孔以A型病变为主，穿孔的原因主要是支架球囊后扩张，覆膜支架为封堵穿孔有效办法，但覆膜支架再狭窄率高。

英文摘要：

AIM The aim of this study was to analyse the distribution characteristics and the reasons and curative effects of patients with type Ⅲ coronary perforation who planted covered stent during percutaneous coronary intervention. METHODS Retrospective analysis of recorded patients with type Ⅲ coronary artery perforation with the covered stents implantation. RESULTS Coronary artery perforation with the covered stents implantation 28 cases （male 20, female 8）, the average age is 45-85（66±8） years old. The perforation arteries are LAD 20 cases （71%）, LCX 2 cases （7%） and RCA 6 cases （21%）, respectively; The lesion type of perforation arteries are type A 16 cases （57%）, type C 11 cases （39%）, type B2 1 case （4%）, CTO 6 cases （21%）, severe calcification 11 cases （36%） and myocardial bridge 3 cases （11%）, respectively; The causes of perforation are post-expansion with stents balloon 15 cases （54%）, stents expansion 6 cases （ 21%）, post-expansion with post-expansion balloon 3 cases （11%）, and guidewire （11%）, respectively. The rate of pericardial tamponade is 61%. The success rates of sealing the rupture site by covered stent is 86%.The in-hospital mortality and major adverse cardiac event rate are 11% and 32%, respectively. 7 cases are followed with CAG, and more than 70% of the stenosis in 3 cases. CONCLUSION The lesion type of type Ⅲ coronary perforation with covered stents is mainly type A and the mainly cause of perforation is post-expansion with stents balloon. The covered stent is an effective way to seal the rupture site with a high success rate but a high restenosis rate.