Glazier J J, Verwilghen J, Morgan J M, Rickards A F
Dept of Invasive Cardiology, Royal Bromptom National Heart and Lung Hospitals, Sydney, London.
Ir Med J. 1992 Dec;85(4):142-44.
When performing coronary angioplasty in patients with multivessel disease, there is an increasing trend to attempt balloon dilation of only ischaemia producing coronary stenoses (a strategy generally associated with incomplete revascularization) rather than attempting to dilate all anatomically significant stenoses (complete revascularization strategy). However the clinical efficacy of the former strategy has been questioned. To explore further this issue, we reviewed the records of 64 consecutive patients with multivessel coronary artery disease undergoing their first angioplasty at our centre in the 15 month period, October 1st 1987 to December 31st 1988. In 59 of these 64 patients, a strategy of incomplete revascularisation [attempted dilation of at least one stenosis > or = 70% but with one or more residual stenoses > or = 70% that were not attempted] was pursued. Of these 59 patients, 18 (31%) has three vessel coronary artery disease [stenoses > or = 70% in all three major coronary artery territories] and 19 (32%) had undergone previous coronary bypass surgery. In all 59 patients, prior to angioplasty, it was attempted to identify the ischaemia producing (so-called 'culprit') lesion(s). In the 59 patients, 66 culprit lesions in 63 vessels were identified. At angioplasty, in all patients, attempted dilation was confined to the culprit lesion(s). Clinical success (successful dilation of all attempted lesions without the occurrence of in-hospital myocardial infarction, death, or coronary bypass surgery) was achieved in 53 (90%) patients. At one year following successful angioplasty, no patient had died or suffered a myocardial infarction.(ABSTRACT TRUNCATED AT 250 WORDS)
在对多支血管病变患者进行冠状动脉血管成形术时，越来越多的趋势是仅对产生缺血的冠状动脉狭窄进行球囊扩张（这一策略通常与不完全血运重建相关），而非试图扩张所有具有解剖学意义的狭窄（完全血运重建策略）。然而，前一种策略的临床疗效受到了质疑。为了进一步探讨这个问题，我们回顾了1987年10月1日至1988年12月31日这15个月期间在我们中心接受首次血管成形术的64例连续性多支冠状动脉疾病患者的记录。在这64例患者中，59例采用了不完全血运重建策略[试图扩张至少一处≥70%的狭窄，但有一处或多处≥70%的残余狭窄未进行扩张]。在这59例患者中，18例（31%）患有三支血管冠状动脉疾病[所有三个主要冠状动脉区域的狭窄≥70%]，19例（32%）曾接受过冠状动脉搭桥手术。在所有59例患者中，血管成形术前试图识别产生缺血的（所谓“罪犯”）病变。在这59例患者中，63支血管中识别出66处罪犯病变。在血管成形术时，所有患者的扩张尝试均局限于罪犯病变。53例（90%）患者取得了临床成功（所有尝试扩张的病变均成功扩张，且未发生院内心肌梗死、死亡或冠状动脉搭桥手术）。在成功进行血管成形术一年后，没有患者死亡或发生心肌梗死。（摘要截选至250字）
