Krucoff M W, Veldkamp R F, Kanani P M, Crater S, Sawchak S R, Wildermann N M, Bengtson J R, Pope J E, Sketch M H, Phillips H R
Department of Medicine, Duke University Medical Center, Durham, North Carolina 27710, USA.
J Invasive Cardiol. 1994 Sep;6(7):234-40.
Long angioplasty inflations have been reported using an autoperfusion system that delivers oxygenated blood distal to the balloon segment. The safety and efficacy of this system has been demonstrated in anatomically selected patients. The clinical use, however, is frequently to stabilize intimal dissection in unselected patients. We reviewed 12-lead continuous electrocardiographic (ECG) recordings in 40 patients in whom prolonged salvage with autoperfusion was attempted. Sub-optimal results were stabilized in 36 of 40, while 4 patients had urgent bypass. The presence of ischemia, as > or = 100 uV ST elevation over the 12 lead ECG, and the total ST deviation over all leads over the entire inflation period (total ischemic "burden") were compared within each patient between the longest standard balloon and autoperfusion inflations. Median duration of inflation was 3.03 min. with balloon vs. 15.6 min. with autoperfusion (p < 0.00002). Of the 40 patients, 35 (87%) had ECG ischemia with balloon vs. 18 (45%) with autoperfusion (p < .00002). Median severity of peak ST deviation was 321 uV with balloon vs. 132 uV with autoperfusion (p = 0.0001). Median extent of ST elevation was 3 leads with balloon vs. 0 leads with autoperfusion (p = 0.0001). Median total ischemic burden was similar with balloon (1173 uVmin) and autoperfusion (1083 uVmin, NS) despite the fivefold longer inflation duration with autoperfusion. Thus, in patients selected by clinical necessity rather than optimal anatomy, severity and extent of ST elevation were significantly reduced, although not entirely eliminated, by autoperfusion.
据报道，使用一种能在球囊段远端输送含氧血液的自动灌注系统进行长时间血管成形术扩张。该系统的安全性和有效性已在经过解剖学筛选的患者中得到证实。然而，其临床应用常常是为了稳定未经过筛选的患者的内膜夹层。我们回顾了40例尝试使用自动灌注进行长时间挽救治疗的患者的12导联连续心电图（ECG）记录。40例患者中有36例次优结果得到稳定，而4例患者进行了紧急搭桥手术。在每位患者中，比较了最长标准球囊扩张和自动灌注扩张时，缺血情况（即12导联心电图上ST段抬高≥100 μV）以及整个扩张期所有导联的总ST段偏移（总缺血“负荷”）。球囊扩张的中位持续时间为3.03分钟，而自动灌注为15.6分钟（p < 0.00002）。40例患者中，球囊扩张时有35例（87%）出现心电图缺血，而自动灌注时有18例（45%）（p < 0.00002）。ST段偏移峰值的中位严重程度，球囊扩张时为321 μV，自动灌注时为132 μV（p = 0.0001）。ST段抬高的中位导联数，球囊扩张时为3个导联，自动灌注时为0个导联（p = 0.0001）。尽管自动灌注的扩张持续时间长五倍，但球囊扩张和自动灌注的中位总缺血负荷相似（分别为1173 μV·min和1083 μV·min，无显著性差异）。因此，在因临床需要而非最佳解剖结构而选择的患者中，自动灌注虽未完全消除，但显著降低了ST段抬高的严重程度和范围。
