Mathias D W, Mooney J F, Lange H W, Goldenberg I F, Gobel F L, Mooney M R
Minneapolis Heart Institute, Abbott Northwestern Hospital, Minnesota 55407.
Am J Cardiol. 1991 Mar 1;67(6):491-5. doi: 10.1016/0002-9149(91)90009-a.
The authors of this study hypothesized that percutaneous transluminal coronary angioplasty of a stenosis at the ostium of a branch vessel, whether isolated or associated with a bifurcation stenosis, was associated with reduced procedural success and increased in-hospital complications. One hundred six patients with 119 ostial branch stenoses were compared with 1,168 patients who underwent angioplasty of nonostial branch stenoses. An ostial branch stenosis was defined as a stenosis in the proximal 3 mm of a major branch vessel (diagonal [n = 58], posterior descending [n = 21], obtuse marginal [n = 34] and intermediate [n = 6]). The ostial branch stenosis was isolated in 61% of the patients and associated with a bifurcation stenosis in 39%. Despite a balloon to artery ratio of 1.05:1, angiographic success was 74% of ostial branch stenoses versus 91% of nonostial stenoses (p less than 0.01). Furthermore, angioplasty of ostial branch stenoses resulted in a complication rate of 13 versus 5% for angioplasty of nonostial branch stenoses (p less than 0.01). Therefore, angioplasty of ostial branch stenoses results in decreased procedural success and significant residual stenosis despite adequate balloon sizing, suggesting arterial elastic recoil and a significant increase in complications.
本研究的作者提出假设，即对分支血管开口处狭窄进行经皮腔内冠状动脉成形术，无论该狭窄是孤立存在还是与分叉处狭窄相关，均与手术成功率降低及院内并发症增加有关。将106例患有119处分支血管开口狭窄的患者与1168例行非分支血管开口狭窄血管成形术的患者进行比较。分支血管开口狭窄定义为主要分支血管近端3毫米处的狭窄（对角支[n = 58]、后降支[n = 21]、钝缘支[n = 34]和中间支[n = 6]）。61%的患者分支血管开口狭窄为孤立性，39%与分叉处狭窄相关。尽管球囊与血管直径比为1.05:1，但分支血管开口狭窄的血管造影成功率为74%，而非分支血管开口狭窄的成功率为91%（p < 0.01）。此外，分支血管开口狭窄血管成形术的并发症发生率为13%，而非分支血管开口狭窄血管成形术的并发症发生率为5%（p < 0.01）。因此，尽管球囊尺寸合适，分支血管开口狭窄血管成形术仍导致手术成功率降低及明显的残余狭窄，提示动脉弹性回缩及并发症显著增加。
