Centro Cardiologico Monzino, IRCCS, Department of Cardiovascular Sciences, University of Milan, Via Parea 4, Milan, Italy.
J Mol Cell Cardiol. 2012 Apr;52(4):883-9. doi: 10.1016/j.yjmcc.2011.09.017. Epub 2011 Sep 24.
A percutaneous coronary intervention (PCI) is a unique condition to study the effects of ischemia and reperfusion in patients with severe coronary atherosclerosis when coronary vasomotor function is compromised by loss of endothelial and autoregulatory vasodilation. We studied the effects of intracoronary non-selective α-, as well as selective α(1)- and α(2)-blockade in counteracting the observed vasoconstriction in patients with stable and unstable angina and in patients with acute myocardial infarction. Coronary vasoconstriction in our studies was a diffuse phenomenon and involved not only the culprit lesion but also vessels with angiographically not visible plaques. Post-PCI vasoconstriction was reflected by increased coronary vascular resistance and associated with decreased LV-function. α (1)-Blockade with urapidil dilated epicardial coronary arteries, improved coronary flow reserve and counteracted LV dysfunction. Non-selective α-blockade with phentolamine induced epicardial and microvascular dilation, while selective α(2)-blockade with yohimbine had only minor vasodilator and functional effects. Intracoronary α-blockade also attenuated the no-reflow phenomenon following primary PCI. This article is part of a Special Issue entitled "Coronary Blood Flow".
经皮冠状动脉介入治疗（PCI）是一种独特的条件，可以研究严重冠状动脉粥样硬化患者在冠状动脉血管舒缩功能因内皮和自动调节性血管扩张丧失而受损时缺血和再灌注的影响。我们研究了非选择性 α 以及选择性 α(1)-和 α(2)-阻断在对抗稳定型和不稳定型心绞痛以及急性心肌梗死患者观察到的血管收缩中的作用。在我们的研究中，冠状动脉收缩是一种弥漫性现象，不仅涉及罪犯病变，还涉及血管造影不可见斑块的血管。PCI 后的血管收缩表现为冠状动脉血管阻力增加，并与 LV 功能降低有关。乌那必利的 α(1)-阻断作用扩张了心外膜冠状动脉，改善了冠状动脉血流储备并对抗了 LV 功能障碍。酚妥拉明的非选择性 α 阻断作用诱导心外膜和微血管扩张，而育亨宾的选择性 α(2)-阻断作用只有较小的血管扩张和功能作用。冠状动脉内 α 阻断作用也减轻了直接 PCI 后的无复流现象。本文是特刊“冠状动脉血流”的一部分。
