Takeshita S, Isshiki T, Tagawa H, Yamaguchi T
Department of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan.
J Invasive Cardiol. 1993 Nov-Dec;5(9):345-50.
Accelerated forms of atherosclerosis continue to be responsible for considerable morbidity and mortality among patients on chronic hemodialysis, and coronary artery disease is responsible for approximately 20-30% of the deaths of such patients. The suitability of such patients for percutaneous transluminal coronary angioplasty (PTCA), however, remains unknown. Accordingly, the purpose of this study was to evaluate the feasibility of PTCA in a group of chronic dialysis patients. PTCA was performed on a total of 15 dialysis patients with medically refractory angina pectoris. Angiographic success was obtained in 16 of 21 (76%) stenoses attempted after the first PTCA. Restenosis was observed in 6 of 16 (38%) lesions, which was significantly related to longer dialysis history (p less than 0.01), and low maximal inflation pressure (p < 0.05). Five of the 6 patients with restenosis underwent a second PTCA, however, all 4 patients with successful second PTCA developed recurrence of angina. Three of 4 patients with a second episode of restenosis underwent a third PTCA, and angina recurred in 2. Thus, PTCA is a reasonable initial strategy for patients with chronic hemodialysis, especially when dialysis history is short. For restenotic lesions and when there is a long dialysis history, restenosis rates are high and coronary bypass surgery should be considered.
在接受慢性血液透析的患者中，动脉粥样硬化的加速形式仍然是导致相当高发病率和死亡率的原因，冠状动脉疾病约占此类患者死亡人数的20%至30%。然而，这类患者是否适合经皮腔内冠状动脉成形术（PTCA）仍不清楚。因此，本研究的目的是评估PTCA在一组慢性透析患者中的可行性。对总共15例患有药物难治性心绞痛的透析患者进行了PTCA。首次PTCA后，在尝试的21处狭窄中有16处（76%）获得了血管造影成功。在16处病变中有6处（38%）观察到再狭窄，这与更长的透析病史（p<0.01）和较低的最大扩张压力（p<0.05）显著相关。6例再狭窄患者中有5例接受了第二次PTCA，然而，第二次PTCA成功的4例患者均出现心绞痛复发。4例第二次再狭窄患者中有3例接受了第三次PTCA，其中2例再次出现心绞痛。因此，PTCA对于慢性血液透析患者是一种合理的初始策略，尤其是透析病史较短时。对于再狭窄病变以及透析病史较长时，再狭窄率很高，应考虑冠状动脉搭桥手术。
