Dietz Ulrich, Rupprecht Hans-Jürgen, de Belder Marc A, Wijns William, Quarles van Ufford Michael A, Klues Heinrich G, vom Dahl Jürgen
University Hospital, Mainz, Germany.
Am J Cardiol. 2002 Oct 15;90(8):843-7. doi: 10.1016/s0002-9149(02)02705-4.
Patients with diffuse in-stent restenoses (ISRs) are at high risk for recurrent restenosis after percutaneous transluminal balloon angioplasty (PTCA). Percutaneous transluminal rotational ablation (PTCR) has proved effective in removing neointimal burden in ISRs. This study compares the acute and long-term results of PTCA and PTCR for the treatment of diffuse ISR in a randomized, multicenter investigation. The primary end point was the comparison of the minimum luminal diameter (MLD) between both groups at 6-month follow-up. Patients with symptomatic, diffuse, or high-grade ISRs were included; 146 patients were randomized to PTCA and 152 patients to PTCR. Diameter stenosis was reduced from 80 +/- 12% to 29 +/- 10% and from 80 +/- 11% to 28 +/- 12%, respectively, and MLD increased from 0.55 +/- 0.3 to 1.9 +/- 0.3 mm in the PTCA group and from 0.54 +/- 0.3 mm to 1.9 +/- 0.4 mm in the PTCR group. Spasm in the treated vessel and an intermittent slow flow phenomenon occurred more often after rotational ablation (17.7% vs 8.6%, p = 0.001; 5.3% vs 0%, p = 0.007). Minimum stenosis diameter at 6-month follow-up was smaller in the PTCR group than in the PTCA group (1.0 +/- 0.6 vs 1.2 +/- 0.6 mm, p = 0.008) and the restenosis rate was higher (64.9% vs 51.2%, p = 0.027). Procedural factors did not influence long-term outcome. In the PTCR group, the restenosis rate increased with decreasing vessel size, whereas this was not seen in the PTCA group. The lesion length and the baseline diameter stenosis were found to be predictive of restenosis with both treatment strategies; however, a residual diameter stenosis of <30% predicted absence of a restenosis only in the PTCR group. Thus, PTCA and PTCR of diffuse ISRs yield comparable acute angiographic results. The recurrence of a restenosis is higher after PTCR than after PTCA.
弥漫性支架内再狭窄（ISR）患者在经皮腔内球囊血管成形术（PTCA）后发生再狭窄的风险很高。经皮腔内旋切术（PTCR）已被证明在消除ISR中的新生内膜负荷方面是有效的。本研究在一项随机、多中心调查中比较了PTCA和PTCR治疗弥漫性ISR的急性和长期结果。主要终点是两组在6个月随访时的最小管腔直径（MLD）比较。纳入有症状、弥漫性或重度ISR的患者；146例患者随机接受PTCA治疗，152例患者接受PTCR治疗。PTCA组直径狭窄分别从80±12%降至29±10%，MLD从0.55±0.3 mm增加至1.9±0.3 mm；PTCR组直径狭窄从80±11%降至28±12%，MLD从0.54±0.3 mm增加至1.9±0.4 mm。旋切术后治疗血管痉挛和间歇性慢血流现象更常见（17.7%对8.6%，p = 0.001；5.3%对0%，p = 0.007）。PTCR组6个月随访时的最小狭窄直径小于PTCA组（1.0±0.6对1.2±0.6 mm，p = 0.008），再狭窄率更高（64.9%对51.2%，p = 0.027）。手术因素不影响长期结果。在PTCR组，再狭窄率随血管尺寸减小而增加，而PTCA组未观察到这种情况。发现病变长度和基线直径狭窄对两种治疗策略的再狭窄均有预测作用；然而，残余直径狭窄<30%仅在PTCR组预测无再狭窄。因此，弥漫性ISR的PTCA和PTCR产生相当的急性血管造影结果。PTCR后再狭窄的复发率高于PTCA后。
