Sütsch G, Kiowski W, Bossard A, Lüscher T F, Maier W, Vogt P, Amann F W
Department of Medicine, University Hospital, Zurich.
Schweiz Med Wochenschr. 2000 Aug 19;130(33):1135-45.
Prevention of distal embolisation during percutaneous coronary revascularisation may be necessary to reduce postinterventional morbidity and mortality.
We employed a newly developed emboli containment and retrieval system in native coronary arteries during percutaneous coronary angioplasty and stenting in 39 selected patients (mean age 58.9 +/- 10.1 years, 11 females) presenting with acute (n = 22; 8 LAD, 3 LCX, 11 RCA), subacute (n = 7; 2 LAD, 2 LCX, 3 RCA) or chronic (n = 6; 2 LAD, 4 RCA) total or subtotal occlusion of an infarct-related vessel, or with severe stenosis and symptoms of unstable angina (n = 4; 2 LAD, 2 RCA). Protection device-assisted angioplasty with stent implantation was uneventful in all patients with good angiographic results and normal postprocedural flow. Intermittent aggravation of anginal pain during inflation of the occlusive balloon (from 2.5 to a maximum of 25 minutes cumulative inflation time) was observed in 19 of the 36 conscious patients (7 with acute, 7 with subacute and 3 with chronic occlusion, and 2 with unstable angina), but caused neither interruption of distal occlusion nor haemodynamic instability. In 31 patients the aspirates contained visible debris. Histological analysis showed particles up to 12 mm in size, consisting of necrotic core, inflammatory cells, cholesterol debris, and old and fresh thrombi. In 8 patients the aspirated particles were too small to allow microscopic diagnosis or debris was absent.
This preliminary report demonstrates the feasibility of using a protection device in native coronary arteries to prevent distal embolisation of particulate matter that is mobilised during percutaneous interventions. To the extent that this material contributes to the mechanisms of distal embolisation, noreflow and infarction, this device may help to reduce such complications. Appropriately designed trials are required to assess the clinical benefit of this system.
在经皮冠状动脉血运重建过程中预防远端栓塞对于降低介入治疗后的发病率和死亡率可能是必要的。
我们在39例选定患者（平均年龄58.9±10.1岁，11例女性）的天然冠状动脉中使用了一种新开发的栓子封堵和取出系统，这些患者表现为急性（n = 22；8例左前降支，3例左旋支，11例右冠状动脉）、亚急性（n = 7；2例左前降支，2例左旋支，3例右冠状动脉）或慢性（n = 6；2例左前降支，4例右冠状动脉）梗死相关血管的完全或次全闭塞，或伴有严重狭窄和不稳定型心绞痛症状（n = 4；2例左前降支，2例右冠状动脉）。所有患者在保护装置辅助下进行血管成形术并植入支架，血管造影结果良好且术后血流正常，过程顺利。36例清醒患者中有19例（7例急性、7例亚急性、3例慢性闭塞和2例不稳定型心绞痛患者）在闭塞球囊充盈期间（累计充盈时间从2.5分钟至最长25分钟）出现心绞痛间歇性加重，但未导致远端闭塞中断或血流动力学不稳定。31例患者的吸出物中含有可见碎片。组织学分析显示颗粒大小达12毫米，由坏死核心、炎症细胞、胆固醇碎片以及新旧血栓组成。8例患者吸出的颗粒太小无法进行显微镜诊断或未发现碎片。
本初步报告证明了在天然冠状动脉中使用保护装置预防经皮介入过程中移动的颗粒物质远端栓塞的可行性。鉴于这种物质促成了远端栓塞、无复流和梗死的机制，该装置可能有助于减少此类并发症。需要进行适当设计的试验来评估该系统的临床益处。
