Kimball B P, Bui S, Dafopoulos N
Cardiovascular Investigation Unit, Toronto General Hospital, Ontario.
Can J Cardiol. 1990 Oct;6(8):327-32.
To examine the morphologic features of stenotic segments developing abrupt coronary occlusion during elective angioplasty, 36 cases occurring at the Toronto General Hospital between January 1985 and December 1989 were evaluated and compared with a temporally matched successful group. Quantitative arteriographic analysis was performed, including estimates of arterial tortuosity (proximal-stenotic axis deviation) and qualitative assessment for dystrophic calcification, residual lumen eccentricity and intimal irregularity. Acute occlusion occurred more frequently in the mid-arterial segment (success, mid 14 versus occlusion 21, P less than 0.05). Stenosis severity assessed by minimum stenotic diameter did not affect outcome (success 0.42 mm versus occlusion 0.37 mm, not significant or relative percentage diameter stenosis (success 86% versus occlusion 86%, not significant). Average stenotic length was equal (success 14.3 mm versus occlusion 13.6 mm, not significant), although coronary arterial tortuosity was increased in the acute occlusion group (success 27 degrees versus occlusion 34 degrees, P less than 0.05). Residual lumen eccentricity score was increased (success 1.66 versus occlusion 2.69, P less than 0.001), with greater dystrophic calcification in the occlusion group (success 0.31 versus occlusion 0.69, P less than 0.05). In addition, intimal irregularity was significantly greater (success 1.65 versus occlusion 2.5, P less than 0.001), although major arterial side branches failed to predict outcome (success 28% versus occlusion 36%, not significant). These data suggested that a mid-coronary anatomic location, arterial tortuosity, lumen eccentricity, dystrophic calcification and intimal irregularity increased the probability of acute occlusion during elective coronary angioplasty.
为了研究择期血管成形术期间发生冠状动脉急性闭塞的狭窄节段的形态学特征，对1985年1月至1989年12月在多伦多综合医院发生的36例病例进行了评估，并与同期匹配的成功组进行比较。进行了定量血管造影分析，包括动脉迂曲度（近端-狭窄轴偏差）的评估以及对营养不良性钙化、残余管腔偏心度和内膜不规则性的定性评估。急性闭塞在动脉中段更常见（成功组，中段14例与闭塞组21例，P<0.05）。通过最小狭窄直径评估的狭窄严重程度不影响结果（成功组0.42mm与闭塞组0.37mm，无显著差异）或相对直径狭窄百分比（成功组86%与闭塞组86%，无显著差异）。平均狭窄长度相等（成功组14.3mm与闭塞组13.6mm，无显著差异），尽管急性闭塞组冠状动脉迂曲度增加（成功组27度与闭塞组34度，P<0.05）。残余管腔偏心度评分增加（成功组1.66与闭塞组2.69，P<0.001），闭塞组营养不良性钙化更严重（成功组0.31与闭塞组0.69，P<0.05）。此外，内膜不规则性显著更大（成功组1.65与闭塞组2.5，P<0.001），尽管主要动脉侧支未能预测结果（成功组28%与闭塞组36%，无显著差异）。这些数据表明，冠状动脉中段解剖位置、动脉迂曲度、管腔偏心度、营养不良性钙化和内膜不规则性增加了择期冠状动脉血管成形术期间急性闭塞的可能性。
