Titus B G, Auth D C, Ritchie J L
Department of Medicine, University of Washington, Seattle.
Cathet Cardiovasc Diagn. 1990 Apr;19(4):279-85. doi: 10.1002/ccd.1810190412.
To determine the incidence and extent of distal embolization during percutaneous transluminal balloon angioplasty (PTA) and rotational thrombectomy (PRT), we collected, filtered, and weighed the distal effluent of acute thrombotically occluded canine arteries following mechanical thrombolysis. PRT (n = 11) and PTA (n = 10) were equally effective in recanalizing occluded vessels (91% vs. 90%) and reduced percent diameter stenosis to a similar degree (97 +/- 6% to 8 +/- 11% and 100 +/- 0% to 17 +/- 23%, respectively). Distal embolization following mechanical intervention was observed in 10 of 10 and 8 of 9 arteries recanalized with PRT and PTA, respectively. The mean weights of collected emboli were similar between the two groups (18 +/- 24 mg vs. 37 +/- 79 mg, PRT vs. PTA, P = NS), although the range of size and weight of thromboemboli was larger in the PTA group (0-206 mg vs. 2-51 mg, PRT). Angiographically defined residual thrombus was significantly less frequent in arteries recanalized with PRT as compared with PTA (10% vs. 55%, P = 0.03). In summary, PRT and PTA are equally effective in recanalizing acutely occluded canine arteries and result in similar reductions in percent diameter stenosis. Each intervention results in distal embolization of thrombi. PRT is associated with a reduced incidence of angiographically evident residual thrombus at the site of arterial injury and may avoid embolization of large fragments occasionally produced by PTA. Thus PRT may serve as a useful alternative to coronary angioplasty during acute myocardial infarction.
为了确定经皮腔内球囊血管成形术（PTA）和旋转血栓切除术（PRT）期间远端栓塞的发生率和程度，我们收集、过滤并称重了急性血栓闭塞犬动脉在机械溶栓后的远端流出物。PRT组（n = 11）和PTA组（n = 10）在使闭塞血管再通方面同样有效（91% 对 90%），并且将直径狭窄百分比降低到相似程度（分别从97±6%降至8±11%和从100±0%降至17±23%）。在分别接受PRT和PTA再通的10条动脉中的10条和9条动脉中的8条中观察到机械干预后的远端栓塞。两组收集到的栓子平均重量相似（PRT组为18±24 mg，PTA组为37±79 mg，P = 无显著性差异），尽管PTA组血栓栓塞的大小和重量范围更大（PRT组为2 - 51 mg，PTA组为0 - 206 mg）。与PTA相比，PRT再通的动脉中血管造影定义的残余血栓明显更少（10% 对 55%，P = 0.03）。总之，PRT和PTA在使急性闭塞的犬动脉再通方面同样有效，并且在降低直径狭窄百分比方面效果相似。每种干预都会导致血栓的远端栓塞。PRT与动脉损伤部位血管造影显示的残余血栓发生率降低相关，并且可能避免PTA偶尔产生的大碎片的栓塞。因此，PRT可能是急性心肌梗死期间冠状动脉成形术的一种有用替代方法。
