Johansson S R, Ekström L, Emanuelsson H
Department of Cardiology, University of Göteborg, Sahlgrenska Hospital, Sweden.
Angiology. 1991 Apr;42(4):273-80. doi: 10.1177/000331979104200403.
Recurrent stenosis after percutaneous transluminal coronary angioplasty (PTCA) is a significant problem, requiring repeat dilation in about one-third of all treated patients. Various clinical and procedure-related predictors have been proposed. Between 1983 and 1987, 257 patients underwent 322 procedures, where 380 stenoses were attempted. Indications were: stable angina pectoris 73%, unstable angina pectoris 22%, other indication 5%. The primary success rate was defined as a less than 50% remaining postprocedure stenosis.
Repeat angiograms were done for 88% of the initially successful cases, either six months after PTCA or if there was a clinical recurrence. Restenosis was defined as a recurrence of a more than 50% diameter stenosis. The restenosis rate was 33% and was significantly higher (p less than 0.05) for unstable (46%) than for stable angina pectoris (29%). There was a nonsignificant tendency to a higher restenosis rate in the left anterior descending artery than in the other coronary vessels.
The increased restenosis rate seen after PTCA for unstable angina pectoris could be caused by a higher activity in systems affecting the proliferative processes in the smooth muscle cells of the arterial wall, which is thought to form the pathophysiologic basis for restenosis after PTCA.
经皮腔内冠状动脉成形术（PTCA）后再发狭窄是一个重要问题，约三分之一接受治疗的患者需要再次扩张。已经提出了各种临床和与操作相关的预测因素。1983年至1987年间，257例患者接受了322次手术，其中尝试治疗380处狭窄。适应证为：稳定型心绞痛73%，不稳定型心绞痛22%，其他适应证5%。主要成功率定义为术后狭窄残留小于50%。
对88%最初成功的病例进行了复查血管造影，时间为PTCA术后6个月或出现临床复发时。再狭窄定义为直径狭窄超过50%的复发。再狭窄率为33%，不稳定型心绞痛患者（46%）的再狭窄率显著高于稳定型心绞痛患者（29%）（p<0.05）。左前降支的再狭窄率高于其他冠状动脉血管，但差异无统计学意义。
不稳定型心绞痛患者PTCA术后再狭窄率增加，可能是由于影响动脉壁平滑肌细胞增殖过程的系统活性较高，这被认为是PTCA术后再狭窄的病理生理基础。
