Azuma A, Sawada T, Katsume H, Kawata K, Terashima S, Ohnishi K, Tatsukawa H, Sugihara H, Kohno Y, Nakagawa M
Second Department of Medicine, Kyoto Prefectural University of Medicine.
J Cardiol. 1991;21(4):879-88.
To determine the optimal balloon-to-artery ratio in percutaneous transluminal coronary angioplasty (PTCA), the effects of balloon size on the extent of residual stenosis, the incidence of coronary dissection, and the percentage of cases requiring repeat PTCA for restenosis were examined retrospectively. Fifty consecutive patients who underwent elective PTCA for simple and discrete lesion localized in the left anterior descending coronary artery were selected for this study. To measure the absolute cross-sectional area of the adjacent control segment of the artery, we developed a new method of quantitative coronary angiography, a hybrid of cinevideodensitometry and the edge detection method. The balloon-to-artery ratio was calculated as the cross-sectional area ratio between the control segment adjacent to the stenosis and the balloon which was visually selected by the operator during PTCA. Residual stenosis was determined as the percent area of stenosis by our hybrid method using cinevideodensitometry. The balloon-to-artery ratio ranged from 0.4 to 2.4, and a weak but significant inverse correlation (r = -0.51) was observed between the balloon-to-artery ratio and the extent of residual stenosis. In 23 patients whose balloon-to-artery ratios were less than 1.0, residual stenosis was greater (59.9 +/- 11.9% vs 46.0 +/- 19.6%, p < 0.05), and the percentage of repeat PTCA was higher (26% vs 4%, p < 0.05) than in the group of 27 patients whose balloon-to-artery ratios were higher than 1.0. The incidence of coronary dissection was similar in the 2 groups (9% vs 15%, ns). The percent area of stenosis before PTCA, the number of inflations, the inflation pressures, and the inflation times were also similar between these 2 groups. We concluded that the optimal balloon size is slightly more than the control segment dimensions of simple and discrete isolated stenoses of the left anterior descending artery treated at lower inflation pressures, and that an accurate measurement method of the coronary arterial dimensions is necessary to determine this optimal balloon size.
为确定经皮腔内冠状动脉成形术（PTCA）中最佳的球囊与动脉比例，我们回顾性研究了球囊大小对残余狭窄程度、冠状动脉夹层发生率以及因再狭窄需重复PTCA的病例百分比的影响。本研究选取了50例连续接受择期PTCA的患者，其病变为位于左前降支冠状动脉的简单、孤立性病变。为测量动脉相邻对照节段的绝对横截面积，我们开发了一种新的定量冠状动脉造影方法，该方法结合了电影视频密度测定法和边缘检测法。球囊与动脉比例通过狭窄相邻对照节段与术者在PTCA过程中肉眼选择的球囊的横截面积之比来计算。残余狭窄通过我们使用电影视频密度测定法的混合方法确定为狭窄面积百分比。球囊与动脉比例范围为0.4至2.4，并且观察到球囊与动脉比例和残余狭窄程度之间存在弱但显著的负相关（r = -0.51）。在23例球囊与动脉比例小于1.0的患者中，残余狭窄程度更高（59.9±11.9% 对46.0±19.6%，p < 0.05），并且重复PTCA的百分比高于球囊与动脉比例高于1.0的27例患者组（26% 对4%，p < 0.05）。两组冠状动脉夹层的发生率相似（9% 对15%，无显著性差异）。这两组患者PTCA前的狭窄面积百分比、充盈次数、充盈压力和充盈时间也相似。我们得出结论，最佳球囊大小略大于在较低充盈压力下治疗的左前降支简单、孤立性狭窄的对照节段尺寸，并且确定此最佳球囊大小需要一种准确的冠状动脉尺寸测量方法。
