Monassier J P, Hanssen M, Katz O, Zimmermann A
Service de cardiologie, clinique Saint-Joseph, Colmar.
Rev Prat. 1990 Nov 11;40(26):2421-30.
Thirteen years after its introduction transluminal balloon catheter angioplasty is a widely used technique. Owing to major technological advances and to the experience acquired by surgical teams, the primary success rate now reaches 90 p. 100. Hospital mortality has fallen down to 1 p. 100 and the need for emergency aorto-coronary bypass has been reduced to 4 p. 100 of the cases. However, despite repeated attempts at pharmacological or mechanical prevention, the restenosis rate remains around 30 p. 100. Coronary angioplasty is part of a wider strategy of myocardial reperfusion. Its indications are roughly the same as those of surgery. In patients with one-vessel coronary disease angioplasty is the first choice treatment, except for unprotected restenosis of the common trunk or very proximal lesions of the anterior interventricular artery. In multiple vessel disease the more complex the anatomical situation the more pronounced the left ventricular dysfunction and the greater the need for surgery. The acute phase of myocardial infarction is a legitimate indication for angioplasty, notably when thrombolytic agents are contraindicated or have failed when given intravenously, or in case of recurrence after an initially successful thrombolysis.
经腔球囊导管血管成形术自应用13年以来，已成为一种广泛使用的技术。由于重大的技术进步以及手术团队积累的经验，目前其首次成功率达到90%。医院死亡率已降至1%，急诊主动脉冠状动脉搭桥术的需求已减少至病例数的4%。然而，尽管在药物或机械预防方面反复尝试，再狭窄率仍保持在30%左右。冠状动脉血管成形术是更广泛的心肌再灌注策略的一部分。其适应症与手术大致相同。在单支冠状动脉疾病患者中，血管成形术是首选治疗方法，但主干无保护的再狭窄或前室间动脉非常近端的病变除外。在多支血管疾病中，解剖情况越复杂，左心室功能障碍越明显，手术需求就越大。心肌梗死急性期是血管成形术的合理适应症，特别是在溶栓药物禁忌或静脉给药失败时，或在最初成功溶栓后复发的情况下。
