Kaltenbach M, Vallbracht C, Hartmann A
Abteilung für Kardiologie, Universität Frankfurt/M.
Fortschr Med. 1991 May 30;109(16):331-6, 340.
Total coronary artery occlusion is the main limiting factor of non-surgical recanalization procedures. With conventional methods, recanalization of total occlusions older than 6 months has a low success rate. Low-speed rotational angioplasty (ROTACS, Osypka, Medtronic) was employed in 152 patients with chronic coronary occlusions in whom conventional guide wire techniques failed. The average success rate was 60% and, although not correlated to site of occlusion, revealed a clear correlation to the duration of the occlusion: 93% (1-3 months), 74% (4-6 months), 52% (6-12 months) and 8% (greater than 12 months). Emergency surgery was needed in 2 patients in whom an attempt was made to recanalize an occluded LAD branch. In both cases, the occlusion was located in the immediate vicinity of the main trunk of the left coronary artery. Thereafter, this anatomical situation was considered a contraindication and no further complications occurred in the subsequent 120 patients. Among the 152 patients, no deaths, no myocardial infarction and no perforation of the vessel wall occurred. Long-term results were monitored by angiography in 95% of successfully treatment patients; good results were documented in 72%.
冠状动脉完全闭塞是非手术再通术的主要限制因素。采用传统方法时，闭塞时间超过6个月的完全闭塞病变再通成功率较低。152例慢性冠状动脉闭塞且传统导丝技术失败的患者接受了低速旋磨术（ROTACS，奥西普卡公司，美敦力公司）。平均成功率为60%，虽然与闭塞部位无关，但与闭塞持续时间明显相关：闭塞1至3个月的成功率为93%，4至6个月的为74%，6至12个月的为52%，超过12个月的为8%。在2例试图再通闭塞的左前降支分支的患者中需要急诊手术。在这两例中，闭塞均位于左冠状动脉主干附近。此后，这种解剖情况被视为禁忌证，在随后的120例患者中未再出现并发症。152例患者中未发生死亡、心肌梗死及血管壁穿孔。95%成功治疗的患者通过血管造影监测长期结果；72%记录为效果良好。
