Ferguson J J, Barasch E, Wilson J M, Strony J, Wolfe M W, Schweiger M J, Leya F, Bonan R, Isner J M, Roubin G S
St. Luke's Episcopal Hospital, Texas Heart Institute, Baylor College of Medicine, Houston, USA.
J Invasive Cardiol. 1995 Jan-Feb;7(1):2-10.
Although the development of thrombus or dissection during percutaneous transluminal coronary angioplasty (PTCA) increases the risk of abrupt vessel closure, the magnitude of the effect is difficult to define.
The aim of the study was to determine prospectively the effect of the development of thrombus or dissection on PTCA procedural outcome.
Data from 591 consecutive angioplasty procedures involving 756 lesions at 9 clinical centers were included in a prospective registry with a core angiographic laboratory.
Clinical success (defined as < 50% stenosis of all target lesions assessed in a core angiographic laboratory, with no major complications of death, Q wave or non-Q wave myocardial infarction or emergency CABG) was achieved in 497 patients (84%). Major complications occurred in 45 (7.6%). Abrupt vessel closure, including both established closure (TIMI grade 0 or I flow) and impending closure (> 50% stenosis, TIMI grade 0-2 flow, plus use of additional interventions) occurred in 65 patients (11%). Angiographically visible dissections developed in 40% of lesions; more severe grades of dissection were associated with reduced success rates, and increased incidence of and abrupt vessel closure and major complication. Angiographic evidence of thrombus (filling defects) developed in 12.3% of lesions; the presence of thrombus was associated with significantly lower procedural success (61% vs. 86%) and significantly higher rates of abrupt vessel closure (28% vs 7%) and major complications (24% vs. 6%). With multivariable analysis, thrombus was identified as an independent predictor of procedural success, abrupt vessel closure, and major complications.
The development of severe dissections or thrombus following PTCA is associated with significantly lower procedural success rates and higher rates of abrupt vessel closure and major complications. Patients who develop severe dissection or thrombus may be appropriate candidates for more aggressive forms of therapy.
尽管经皮腔内冠状动脉成形术（PTCA）期间血栓形成或夹层的发生会增加血管突然闭塞的风险，但这种影响的程度难以确定。
本研究的目的是前瞻性地确定血栓形成或夹层的发生对PTCA手术结果的影响。
来自9个临床中心的591例连续血管成形术的数据，涉及756个病变，被纳入一个带有核心血管造影实验室的前瞻性登记研究。
497例患者（84%）获得临床成功（定义为核心血管造影实验室评估的所有靶病变狭窄<50%，无死亡、Q波或非Q波心肌梗死或急诊冠状动脉旁路移植术等主要并发症）。45例（7.6%）发生主要并发症。65例患者（11%）发生血管突然闭塞，包括已确定的闭塞（TIMI 0级或I级血流）和即将发生的闭塞（>50%狭窄，TIMI 0 - 2级血流，加上使用额外干预措施）。40%的病变出现血管造影可见的夹层；更严重程度的夹层与成功率降低、血管突然闭塞和主要并发症的发生率增加相关。12.3%的病变出现血栓的血管造影证据（充盈缺损）；血栓的存在与手术成功率显著降低（61%对86%）、血管突然闭塞率显著升高（28%对7%）和主要并发症发生率显著升高（24%对6%）相关。多变量分析显示，血栓是手术成功、血管突然闭塞和主要并发症的独立预测因素。
PTCA后严重夹层或血栓的发生与手术成功率显著降低、血管突然闭塞率和主要并发症发生率升高相关。发生严重夹层或血栓的患者可能是更积极治疗形式的合适候选者。
