Eichhorn E J, Grayburn P A, Willard J E, Anderson H V, Bedotto J B, Carry M, Kahn J K, Willerson J T
Cardiac Catheterization Laboratory, Dallas Veterans Administration Hospital, Texas.
J Am Coll Cardiol. 1991 Jan;17(1):43-52. doi: 10.1016/0735-1097(91)90702-b.
Cyclic coronary artery flow variations with a spontaneous decline in coronary blood flow to very low levels have been documented in stenosed canine coronary arteries with endothelial injury. These flow variations are associated with transient platelet aggregation and dislodgment and the release of selected mediators, including thromboxane A2 and serotonin. However, cyclic or spontaneous flow variations have not been demonstrated in stenosed coronary arteries in humans. In this study, the hypothesis was tested that spontaneous coronary blood flow velocity variations occur in some patients with stenosed coronary arteries before or after coronary artery angioplasty. Thus, 13 patients with severe and limiting angina underwent intracoronary pulsed Doppler velocimetry of their dilated artery immediately before and after percutaneous transluminal coronary angioplasty, whereas 9 control patients underwent velocimetry of an angiographically normal coronary artery. A 3F catheter with a 20 MHz Doppler crystal was positioned to achieve a maximal stable signal, and the flow velocity signal was recorded continuously for 20 min. Spontaneous flow velocity variations (greater than or equal to 38% change in Doppler frequency shift with wide morphologic changes) were present in 3 of the 13 patients tested. Spontaneous flow velocity variations occurred before angioplasty in one patient, after angioplasty in another and both before and after angioplasty in a third. In addition, 2 of the 13 patients, 1 with spontaneous coronary artery flow velocity variations before angioplasty, had frank vasospasm in an adjacent area just distal to the area of coronary dilation immediately after balloon inflation. These data establish that spontaneous coronary artery flow velocity variations occur in some patients with severe and limiting angina before and after coronary angioplasty. These variations may be related to platelet aggregation or coronary vasoconstriction, or both, at sites of endothelial injury resulting from plaque fissuring or ulceration and endothelial and medial injury occurring during coronary angioplasty.
在患有内皮损伤的狭窄犬冠状动脉中，已记录到冠状动脉血流呈周期性变化，冠状动脉血流会自发下降至极低水平。这些血流变化与短暂的血小板聚集和脱落以及某些介质的释放有关，这些介质包括血栓素A2和血清素。然而，在人类狭窄冠状动脉中尚未证实存在周期性或自发性血流变化。在本研究中，对以下假设进行了验证：一些冠状动脉狭窄患者在冠状动脉血管成形术之前或之后会出现自发性冠状动脉血流速度变化。因此，13例患有严重且有局限性心绞痛的患者在经皮腔内冠状动脉血管成形术前后立即对其扩张的动脉进行了冠状动脉内脉冲多普勒测速，而9例对照患者对造影显示正常的冠状动脉进行了测速。将带有20 MHz多普勒晶体的3F导管放置在合适位置以获得最大稳定信号，并连续记录20分钟的血流速度信号。在13例接受测试的患者中，有3例出现了自发性血流速度变化（多普勒频移变化大于或等于38%，形态变化较大）。自发性血流速度变化在1例患者血管成形术前出现，在另1例患者血管成形术后出现，在第3例患者血管成形术前后均出现。此外，13例患者中有2例，其中1例在血管成形术前有自发性冠状动脉血流速度变化，在球囊扩张后，紧邻冠状动脉扩张区域的远侧相邻区域出现了明显的血管痉挛。这些数据表明，一些患有严重且有局限性心绞痛的患者在冠状动脉血管成形术前后会出现自发性冠状动脉血流速度变化。这些变化可能与斑块破裂或溃疡导致的内皮损伤部位以及冠状动脉血管成形术期间发生的内皮和中层损伤部位的血小板聚集或冠状动脉血管收缩，或两者都有关。
