Umans V A, Strauss B H, Rensing B J, de Jaegere P, de Feyter P J, Serruys P W
Catherization Laboratory, University Hospital Dijkzigt, Erasmus University Rotterdam, The Netherlands.
Am Heart J. 1991 Sep;122(3 Pt 1):836-43. doi: 10.1016/0002-8703(91)90533-n.
Interventional cardiology has branched in two directions: devices that primarily dilate coronary stenoses and those that debulk coronary tissue. Presently the optimum coronary intervention has not been found. While patients are awaiting randomized trials, a comparison based on matched quantitative coronary analysis may be useful to evaluate results of new interventional techniques. Therefore we compared 51 patients undergoing atherectomy with individually matched patients who were undergoing balloon angioplasty and stenting. The lesions were matched according to location of stenosis and reference diameter. Atherectomy and stenting resulted in larger gains in minimal luminal diameter compared with conventional balloon angioplasty. The minimal luminal diameter was increased from 1.2 +/- 0.4 mm to 2.6 +/- 0.4 mm in the atherectomy group and from 1.2 +/- 0.3 mm to 1.9 +/- 0.4 mm in the angioplasty group (p less than 0.00001). Atherectomy and stenting resulted in similar gains in minimum luminal diameter (1.4 mm vs 1.3 mm, p = NS). In addition, atherectomy and stenting appear to be more effective in resisting elastic recoil because of tissue removal and an intrinsic dilating effect, respectively. In matched populations directional atherectomy and stenting appear to be more effective intracoronary interventional devices than balloon angioplasty based on the immediate results. However, atherectomy is limited in smaller coronary vessels because of its larger size.
主要用于扩张冠状动脉狭窄的器械和用于减少冠状动脉组织体积的器械。目前尚未找到最佳的冠状动脉介入治疗方法。在患者等待随机试验的同时，基于匹配的定量冠状动脉分析进行比较可能有助于评估新介入技术的效果。因此，我们将51例行旋切术的患者与单独匹配的接受球囊血管成形术和支架置入术的患者进行了比较。病变根据狭窄部位和参考直径进行匹配。与传统球囊血管成形术相比，旋切术和支架置入术使最小管腔直径有更大的增加。旋切术组的最小管腔直径从1.2±0.4毫米增加到2.6±0.4毫米，血管成形术组从1.2±0.3毫米增加到1.9±0.4毫米（p<0.00001）。旋切术和支架置入术使最小管腔直径的增加相似（1.4毫米对1.3毫米，p=无显著性差异）。此外，由于分别有组织切除和内在扩张作用，旋切术和支架置入术在抵抗弹性回缩方面似乎更有效。基于即时结果，在匹配人群中，定向旋切术和支架置入术似乎比球囊血管成形术更有效的冠状动脉内介入器械。然而，旋切术因其尺寸较大，在较小的冠状动脉血管中受到限制。
