Kimball B P, Bui S, Carere R G, Cohen E A, Adelman A G
Department of Medicine, Toronto Hospital, Ontario, Canada.
Chest. 1992 Dec;102(6):1676-82. doi: 10.1378/chest.102.6.1676.
To assess the immediate outcome of directional coronary atherectomy (DCA) versus standard balloon angioplasty (PTCA) in de novo left anterior descending coronary stenoses, 25 consecutive atherectomies (22 men, 3 women) performed at The Toronto Hospital, between July 1990 and March 1991 were compared with 25 (14 men, 11 women) temporally matched successful angioplasties. Coronary stenoses were analyzed by quantitative arteriography, using the Coronary Measurement System (Leiden, The Netherlands), with estimation of transstenotic hemodynamics by fluid dynamic equations. Before and after procedure qualitative blood flow (TIMI criteria) was also evaluated, as was intimal haziness and coronary dissection. In comparison to PTCA, coronary atherectomy produced less residual minimum stenotic diameter (DCA, 2.75 +/- 0.55 vs PTCA, 1.70 +/- 0.44 mm, p < 0.001), and relative percent diameter stenosis (DCA, 17.9 +/- 10.7 vs PTCA, 34.4 +/- 10.7 percent, p < 0.001), with less transstenotic obstructive gradient (DCA, 0.2 +/- 0.2 vs PTCA, 1.0 +/- 1.5 mm Hg, p < 0.05), and greater estimated stenotic flow reserve (DCA, 4.86 +/- 0.15 vs PTCA, 4.50 +/- 0.48 x baseline, p < 0.05). Coronary atherectomy "normalized" TIMI flow patterns in virtually all patients (DCA, 2.96 +/- 0.20 vs PTCA, 2.72 +/- 0.45, p < 0.05), while creating less intimal haziness (DCA, 10/25 [40 percent] vs PTCA, 23/25 [92 percent], p < 0.01), and coronary dissection (DCA, 6/25 [24 percent] vs PTCA, 16/25 [64 percent], p < 0.05). Therefore, when compared with standard balloon angioplasty, DCA produces less residual stenosis, better transstenotic hemodynamics, while decreasing the frequency of coronary artery damage, in de novo left anterior descending stenoses.
为评估定向冠状动脉斑块旋切术（DCA）与标准球囊血管成形术（PTCA）治疗初发左前降支冠状动脉狭窄的即刻疗效，将1990年7月至1991年3月在多伦多医院连续进行的25例斑块旋切术（22例男性，3例女性）与25例（14例男性，11例女性）同期匹配的成功血管成形术进行比较。采用冠状动脉测量系统（荷兰莱顿）通过定量血管造影分析冠状动脉狭窄情况，并运用流体动力学方程估算跨狭窄处的血流动力学。术前术后还评估了定性血流（TIMI标准）、内膜模糊程度及冠状动脉夹层。与PTCA相比，冠状动脉斑块旋切术产生的残余最小狭窄直径更小（DCA为2.75±0.55mm，PTCA为1.70±0.44mm，p<0.001），相对直径狭窄百分比更低（DCA为17.9±10.7%，PTCA为34.4±10.7%，p<0.001），跨狭窄处的阻塞梯度更小（DCA为0.2±0.2mmHg，PTCA为1.0±1.5mmHg，p<0.05），估计狭窄血流储备更大（DCA为4.86±0.15，PTCA为4.50±0.48×基线，p<0.05）。冠状动脉斑块旋切术几乎使所有患者的TIMI血流模式“正常化”（DCA为2.96±0.20，PTCA为2.72±0.45，p<0.05），同时产生的内膜模糊程度更低（DCA为10/25[40%]，PTCA为23/25[92%]，p<0.01），冠状动脉夹层更少（DCA为6/25[24%]，PTCA为16/25[64%]，p<0.05）。因此，与标准球囊血管成形术相比，对于初发左前降支狭窄，DCA产生的残余狭窄更少，跨狭窄处血流动力学更好，同时降低了冠状动脉损伤的发生率。
