Dangas G, Cocke TP, Sharma SK, Vidhun RR, Kakarala V, Marmur JD, Ambrose JA
Cardiovascular Institute (Box 1030), Mount Sinai Medical Center, One Gustave L. Levy Place, New York, NY, 10029, USA.
J Invasive Cardiol. 1998 Sep;10(7):372-375.
Early elastic recoil has been implicated in the pathophysiology of restenosis after balloon coronary angioplasty (PTCA). Directional atherectomy (DCA) may significantly attenuate this vessel wall reaction by altering the vessel wall architecture, specifically by removing or injuring the medial smooth muscle cells. We compared the magnitude of early changes in minimal lumen diameter (MLD) after DCA followed by adjunctive PTCA (group I) in comparison to PTCA alone (group II). In two groups of 30 lesions, matched for vessel size and location, group I cases showed significantly less recoil than group II cases, as assessed by routinely performed 15 minute post-procedure angiograms: mean changes in post-procedure MLD +0.06mm (increase) vs. -0.31mm (decrease) respectively, p = 0.02. In a histopathologic substudy of the DCA treated patients, those without early recoil had significantly higher incidence of media removal compared to patients with recoil (50% vs. 7%, p = 0.03). Therefore, early changes in MLD, presumably related to elastic recoil, are less with DCA and adjunct PTCA in comparison to PTCA alone. Attenuation of early recoil may be an additional mechanism accounting for the acute lumen gain achieved with this technique.
早期弹性回缩与球囊冠状动脉成形术（PTCA）后再狭窄的病理生理学有关。定向旋切术（DCA）可能通过改变血管壁结构，特别是通过去除或损伤中层平滑肌细胞，显著减轻这种血管壁反应。我们比较了DCA联合辅助PTCA（第一组）与单纯PTCA（第二组）后最小管腔直径（MLD）早期变化的程度。在两组各30个病变中，根据血管大小和位置进行匹配，通过常规术后15分钟血管造影评估，第一组病例的回缩明显小于第二组病例：术后MLD的平均变化分别为+0.06mm（增加）和-0.31mm（减少），p = 0.02。在对接受DCA治疗患者的组织病理学亚研究中，与有回缩的患者相比，没有早期回缩的患者中层去除的发生率显著更高（50%对7%，p = 0.03）。因此，与单纯PTCA相比，DCA联合辅助PTCA时，推测与弹性回缩相关的MLD早期变化较小。早期回缩的减轻可能是该技术实现急性管腔增加的另一种机制。
