Thaulow E
Medical Department B, University Hospital Oslo, Norway.
J Cardiovasc Pharmacol. 1999;33 Suppl 2:S12-6. doi: 10.1097/00005344-199900002-00004.
The understanding and control of the healing process after percutaneous transluminal coronary angioplasty (PTCA) and of the pathogenesis of restenosis are incomplete. To date, only stent implantation has been shown to successfully reduce the rate of restenosis. Calcium channel blockers have positive effects on a number of processes that may be associated with restenosis, including reduction of platelet aggregation, minimization of vasospasm, and inhibition of mitogens. Clinical trials have therefore been performed to assess the effect of calcium channel blockers on restenosis and ischemia. A meta-analysis of five restenosis trials investigating calcium channel blockers demonstrated a 30% reduction in the risk for restenosis. The Coronary Angioplasty Amlodipine Restenosis Study (CAPARES) is therefore assessing the effect of amlodipine, a long-acting, third-generation calcium channel blocker in angioplasty patients. Therapy (amlodipine 5 mg with a forced titration to 10 mg once daily, or placebo), is begun 2 weeks before angioplasty and is continued for 4 months after the procedure. The rationale of CAPARES is that amlodipine may offer anti-ischemic protection before, during, and after angioplasty, may have more beneficial effects on restenosis and various clinical end points than calcium channel blockers used in previous trials, and may improve the long-term outcome of PTCA therapy.
经皮腔内冠状动脉成形术（PTCA）后愈合过程以及再狭窄发病机制的理解和控制仍不完整。迄今为止，仅支架植入已被证明能成功降低再狭窄率。钙通道阻滞剂对一些可能与再狭窄相关的过程具有积极作用，包括减少血小板聚集、使血管痉挛最小化以及抑制有丝分裂原。因此，已开展临床试验来评估钙通道阻滞剂对再狭窄和局部缺血的影响。一项对五项研究钙通道阻滞剂的再狭窄试验的荟萃分析表明，再狭窄风险降低了30%。因此，冠状动脉成形术氨氯地平再狭窄研究（CAPARES）正在评估长效第三代钙通道阻滞剂氨氯地平对接受血管成形术患者的影响。治疗（氨氯地平5毫克，每日一次强制滴定至10毫克，或安慰剂）在血管成形术前2周开始，并在手术后持续4个月。CAPARES的基本原理是，氨氯地平可能在血管成形术前、术中和术后提供抗缺血保护，对再狭窄和各种临床终点可能比以往试验中使用的钙通道阻滞剂具有更有益的作用，并且可能改善PTCA治疗的长期结果。
