Bonnet J L, Avran A, Quilici J, Fourcade L, Bory M
Service de cardiologie A, CHU Timone, Marseille.
Arch Mal Coeur Vaiss. 1999 Nov;92(11 Suppl):1571-8.
The immediate results of transluminal coronary angioplasty (TCA) have improved considerably during recent years. Balloon dilatation of the arterial stenosis is the basis of this technique of revascularisation but new tools may be used to treat specific lesions. Coronary occlusion is the most feared complication of TCA. It may cause myocardial infarction or death of the patient. It is usually secondary to dissection and/or thrombus of the artery. The implantation of a stent successfully treats most cases of dissection. New anti-platelet (GP IIb/IIIa) drugs seem to be very effective in the prevention and treatment of the thrombosis. The systematic use of ticlopidine limits the risk of stent occlusion. Improved features enable satisfactory implantation of stents in the majority of cases. In some patients, the clinical consequences of occlusion may be limited by vascular bypass techniques, especially intra-aortic balloon pumping. In other cases, emergency coronary bypass surgery may be necessary. When TCA is considered to be a very high risk procedure, effective surgical cover is essential.
近年来，经皮腔内冠状动脉成形术（TCA）的即刻效果有了显著改善。动脉狭窄的球囊扩张是这种血运重建技术的基础，但也可使用新工具来治疗特定病变。冠状动脉闭塞是TCA最可怕的并发症。它可能导致心肌梗死或患者死亡。它通常继发于动脉夹层和/或血栓形成。支架植入成功治疗了大多数夹层病例。新型抗血小板药物（GP IIb/IIIa）似乎在预防和治疗血栓形成方面非常有效。噻氯匹定的系统性使用降低了支架闭塞的风险。改进的特性使大多数情况下能够令人满意地植入支架。在一些患者中，血管旁路技术，尤其是主动脉内球囊反搏，可能会限制闭塞的临床后果。在其他情况下，可能需要急诊冠状动脉搭桥手术。当TCA被认为是一项风险非常高的操作时，有效的手术保障至关重要。
