Timmis S B, Hermiller J B, Burns W H, Meyers S N, Davidson C J
Northwestern Memorial Hospital, Chicago, Illinois 60611, USA.
Am J Cardiol. 1999 Feb 1;83(3):311-6. doi: 10.1016/s0002-9149(98)00859-5.
Angiographic studies have demonstrated that perfusion balloon percutaneous transluminal coronary angioplasty (PTCA) may result in modestly improved luminal gains and fewer major dissections than conventional balloon PTCA. However, intracoronary ultrasound (ICUS), which is more sensitive than angiography in evaluating the incidence, extent, and severity of dissection, was not used. We randomized 48 patients with 54 coronary stenoses to conventional or perfusion balloon PTCA. Four 2-minute inflations were permitted with conventional balloon PTCA. Two 10-minute inflations were allowed with perfusion balloon PTCA. Quantitative coronary angiography and ICUS were performed before and after treatment. In-hospital clinical events were recorded. Conventional and perfusion balloon PTCA achieved similar improvements in lumen diameter (1.25+/-0.51 vs 1.28+/-0.51 mm) and reductions in percent stenosis (-45+/-21% vs -44+/-15%) by quantitative coronary angiography. Comparable gains in lumen diameter (0.62+/-0.39 vs 0.50+/-0.38 mm) and lumen area (2.70+/-1.96 vs 2.05+/-1.52 mm2) were observed on ICUS. Angiography demonstrated similar rates of any dissection (36% vs 21%) and major dissection (12% vs 7%). ICUS identified a similar incidence of any dissection (60% vs 76%) and type II dissection (52% vs 62%). The relative dissection area was also similar (9.2+/-5.6% vs 7.8+/-5.8%). One conventional balloon patient experienced postprocedural chest pain. No patient in either group died, or had myocardial infarction, abrupt closure, or urgent revascularization.
血管造影研究表明，与传统球囊经皮冠状动脉腔内血管成形术（PTCA）相比，灌注球囊PTCA可能会使管腔增益略有改善，且严重夹层形成较少。然而，本研究未使用在评估夹层的发生率、范围和严重程度方面比血管造影更敏感的冠状动脉内超声（ICUS）。我们将48例患有54处冠状动脉狭窄的患者随机分为接受传统球囊PTCA或灌注球囊PTCA治疗。传统球囊PTCA允许进行4次2分钟的球囊充盈。灌注球囊PTCA允许进行2次10分钟的球囊充盈。治疗前后均进行定量冠状动脉造影和ICUS检查。记录住院期间的临床事件。通过定量冠状动脉造影，传统球囊PTCA和灌注球囊PTCA在管腔直径改善方面相似（分别为1.25±0.51 vs 1.28±0.51 mm），狭窄百分比降低方面也相似（分别为-45±21% vs -44±15%）。ICUS观察到管腔直径（分别为0.62±0.39 vs 0.50±0.38 mm）和管腔面积（分别为2.70±1.96 vs 2.05±1.52 mm²）的增益相当。血管造影显示任何夹层的发生率相似（分别为36% vs 21%）以及严重夹层的发生率相似（分别为12% vs 7%）。ICUS识别出任何夹层的发生率相似（分别为60% vs 76%）以及II型夹层的发生率相似（分别为52% vs 62%）。相对夹层面积也相似（分别为9.2±5.6% vs 7.8±5.8%）。1例接受传统球囊治疗的患者术后出现胸痛。两组均无患者死亡、发生心肌梗死、出现急性血管闭塞或接受紧急血管重建治疗。
