Muller D W, Ellis S G, Debowey D L, Topol E J
Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor 48109-0022.
Am J Cardiol. 1990 Oct 15;66(12):938-42. doi: 10.1016/0002-9149(90)90929-u.
Coronary atherectomy and coronary stenting effectively reduce the severity of coronary artery stenoses, but direct comparisons of these interventions with conventional balloon angioplasty have not been performed. To compare the immediate efficacy of these 3 interventions, the angiographic morphology and the severity of the residual coronary stenosis were quantitatively evaluated in 18 patients undergoing coronary atherectomy and in 21 patients treated by endoluminal coronary stenting. Each of these groups of patients was compared with a matched group of coronary angioplasty patients selected from a large, computerized data-base. The variables matched included patient age and sex, lesions site and severity, and lesion complexity. Both coronary atherectomy and coronary stenting more effectively reduced the severity of the coronary stenosis when compared with balloon angioplasty. The luminal diameter stenosis was reduced from 69 +/- 10 to 22 +/- 20% in the atherectomy group compared with a reduction from 74 +/- 11 to 44 +/- 14% in the matched coronary angioplasty population (p = 0.008). Similarly, the luminal diameter stenosis was reduced from 77 +/- 11 to 26 +/- 12% in the stented group compared with a reduction from 81 +/- 10 to 42 +/- 14% in the matched coronary angioplasty group (p = 0.014). In addition, moderate or severe coronary dissections were noted more frequently in the coronary angioplasty groups than in their respective atherectomy and stent groups (0 vs 33%, p = 0.008, and 5 vs 19%, p = 0.15, respectively).(ABSTRACT TRUNCATED AT 250 WORDS)
冠状动脉斑块旋切术和冠状动脉支架置入术能有效降低冠状动脉狭窄的严重程度，但尚未将这些干预措施与传统球囊血管成形术进行直接比较。为比较这三种干预措施的即时疗效，对18例行冠状动脉斑块旋切术的患者和21例行冠状动脉腔内支架置入术的患者的血管造影形态及残余冠状动脉狭窄的严重程度进行了定量评估。将每组患者与从大型计算机数据库中选出的匹配的冠状动脉血管成形术患者组进行比较。匹配的变量包括患者年龄、性别、病变部位和严重程度以及病变复杂性。与球囊血管成形术相比，冠状动脉斑块旋切术和冠状动脉支架置入术都能更有效地降低冠状动脉狭窄的严重程度。斑块旋切术组的管腔直径狭窄从69±10%降至22±20%，而匹配的冠状动脉血管成形术人群的管腔直径狭窄从74±11%降至44±14%（p = 0.008）。同样，支架置入组的管腔直径狭窄从77±11%降至26±12%，而匹配的冠状动脉血管成形术组的管腔直径狭窄从81±10%降至42±14%（p = 0.014）。此外，冠状动脉血管成形术组中中度或重度冠状动脉夹层的发生率高于各自的斑块旋切术组和支架置入组（分别为0%对33%，p = 0.008，以及5%对19%，p = 0.15）。（摘要截短于250词）
