Gai L, Wang J, Huang D
Department of Cardiology, PLA General Hospital, Beijing 100853, China.
Zhonghua Yi Xue Za Zhi. 2000 Jul;80(7):509-12.
To investigate the early natural course of dissection after PTCA and its relation to early luminal deterioration.
One hundred and five patients who underwent relook coronary arteriography within 24 hours of PTCA were retrospectively analyzed. The patients were subdivided into no dissection and type A, B, C, D, and E dissection. Minimal luminal diameter (MLD) was measured immediately after PTCA and at relook coronary arteriography. The changes were correlated with the severity of the dissections.
Immediately after PTCA, the MLD in all 6 groups was > 2.0 mm. Except for type A dissection, the MLD, however, was deteriorated significantly at the relook coronary arteriography next day. The factors contributing to the deterioration were analyzed by covariance analysis, which showed a significant linear relation with the MLD immediately after PTCA and the type of dissection. Multivariate stepwise regression analysis was used to investigate if the patients' demographic factors and coronary lesion characteristics were also related to the MLD deterioration. The results showed that multivessel disease and the type of dissection were two independent risk factors of the MLD deterioration.
Even if the results immediately after PTCA were acceptable, MLD will deteriorate over time. The degree of the deterioration was not only related to elastic recoil, but also to the type of dissection. Type C, D and E dissections were unstable, causing much more damage to the MLD than type A and B dissections, which mandated immediate stent implantation to prevent early luminal deterioration and late restenosis. Stent implantation was usually unnecessary in type A and B dissections. Multivessel disease was also involved in the process of the MLD deterioration. The mechanism is unclear, but might be related to coronary lesion characteristics.
探讨经皮冠状动脉腔内血管成形术（PTCA）后夹层的早期自然病程及其与早期管腔恶化的关系。
回顾性分析105例在PTCA后24小时内行再次冠状动脉造影的患者。将患者分为无夹层组以及A、B、C、D和E型夹层组。在PTCA后即刻及再次冠状动脉造影时测量最小管腔直径（MLD）。将这些变化与夹层的严重程度相关联。
PTCA后即刻，所有6组的MLD均>2.0mm。然而，除了A型夹层外，次日再次冠状动脉造影时MLD显著恶化。通过协方差分析对导致恶化的因素进行分析，结果显示其与PTCA后即刻的MLD以及夹层类型存在显著线性关系。采用多变量逐步回归分析来研究患者的人口统计学因素和冠状动脉病变特征是否也与MLD恶化相关。结果表明，多支血管病变和夹层类型是MLD恶化的两个独立危险因素。
即使PTCA后即刻结果可接受，MLD仍会随时间推移而恶化。恶化程度不仅与弹性回缩有关，还与夹层类型有关。C、D和E型夹层不稳定，对MLD造成的损害远大于A和B型夹层，这就要求立即植入支架以预防早期管腔恶化和晚期再狭窄。A和B型夹层通常无需植入支架。多支血管病变也参与了MLD恶化过程。其机制尚不清楚，但可能与冠状动脉病变特征有关。
