el-Tamimi H, Davies G J, Hackett D, Sritara P, Bertrand O, Crea F, Maseri A
Cardiovascular Research Unit, Royal Postgraduate Medical School, Hammersmith Hospital, London, UK.
Circulation. 1991 Sep;84(3):1198-202. doi: 10.1161/01.cir.84.3.1198.
To study the impact of percutaneous transluminal coronary angioplasty (PTCA) on coronary vasomotion, we prospectively analyzed spontaneous changes in coronary diameter and the response to the cold pressor test and intracoronary nitroglycerin in 11 patients subjected to successful single-vessel PTCA.
All antianginal medications were stopped 48 hours before each study. The minimum diameter of the PTCA segment and the diameter of a distal segment in the angioplastied vessel and of a segment in a control vessel not manipulated by the balloon catheter or guide wire were measured by computerized edge detection immediately before PTCA and 5 minutes after, 4 hours after, and 8 days after PTCA. At 4 hours, PTCA and distal segments were constricted by 38 +/- 9% and 16 +/- 5%, respectively, compared with the values at 5 minutes (p less than 0.01). Before angioplasty, the cold pressor test caused vasoconstriction of PTCA and distal segments by 23 +/- 6% (p less than 0.0001) and 15 +/- 4% (p less than 0.008), respectively, but no constrictor response was elicited at 5 minutes or 4 hours after angioplasty. Eight days after PTCA, the basal coronary diameters were similar to those observed 5 minutes after PTCA and the response to the cold pressor test was similar to that observed before PTCA. All segments dilated significantly with nitroglycerin at all times, and no vasoconstriction changes were found in the control segments.
Four hours after PTCA, transient spontaneous vasoconstriction of the PTCA and distal segments occurs, which is so intense that the cold pressor test does not cause any further constriction. These abnormalities resolve within 8 days of PTCA.
为研究经皮腔内冠状动脉成形术（PTCA）对冠状动脉血管运动的影响，我们前瞻性地分析了11例成功接受单支血管PTCA患者的冠状动脉直径自发变化以及对冷加压试验和冠状动脉内硝酸甘油的反应。
每次研究前48小时停用所有抗心绞痛药物。在PTCA术前即刻、术后5分钟、4小时和8天，通过计算机边缘检测测量PTCA节段的最小直径、血管成形术血管中远段的直径以及未被球囊导管或导丝操作的对照血管节段的直径。在4小时时，与5分钟时的值相比，PTCA节段和远段分别收缩了38±9%和16±5%（p<0.01）。在血管成形术前，冷加压试验使PTCA节段和远段分别收缩23±6%（p<0.0001）和15±4%（p<0.008），但在血管成形术后5分钟或4小时未引起收缩反应。PTCA术后8天，基础冠状动脉直径与PTCA术后5分钟时观察到的相似，对冷加压试验的反应与血管成形术前观察到的相似。所有节段在所有时间点用硝酸甘油后均显著扩张，对照节段未发现血管收缩变化。
PTCA术后4小时，PTCA节段和远段出现短暂的自发血管收缩，收缩程度强烈，以至于冷加压试验不会引起进一步收缩。这些异常在PTCA术后8天内消失。
