Spielberg C, Schnitzer L, Linderer T, Schröder R
Kardiopulmologische Abteilung, Klinikum Steglitz, Freien Universität Berlin.
Z Kardiol. 1990 Jun;79(6):450-4.
We report on the complication rates in 660 consecutive coronary angioplasties (725 lesions) performed using four procedures that differed with respect to catheter technology and adjuvant medication. After the PTCA regimen in our laboratory had been changed from conventional steerable systems to the monorail-technique, we observed an increase in the incidence of intermittent and recurrent vessel occlusions from 2.6% to 7.7%, of permanent occlusions from 3.6% to 8.8%, and of intracoronary thrombus-formation from 2.6% to 5.5%. This was associated with the frequent observation of thrombotic material on the guide wires. Coronary perfusion with urokinase (1670-6670 U/min) lead to a further increase in the complication rates (10.4%/10.3%/6.5%). Our present PTCA-regimen (monorail-technique with PET balloons, silicon-coated guide wires, no urokinase) shows an incidence of 3.8% for intermittent and recurrent coronary occlusions, and of 1.9% for permanent occlusions. We suspect that in case of PTCA-induced regional intimal dissection, fibrinolysis prevents reestablishment of intima-adherence to the vessel wall. We conclude that i.c. urokinase in PTCA is a potentially harmful regimen and that the monorail-technique should be performed with silicon-coated guide wires.
我们报告了连续660例冠状动脉血管成形术（725处病变）的并发症发生率，这些手术采用了四种在导管技术和辅助用药方面有所不同的方法。在我们实验室将经皮腔内冠状动脉血管成形术（PTCA）方案从传统的可控系统改为单轨技术后，我们观察到间歇性和复发性血管闭塞的发生率从2.6%增加到7.7%，永久性闭塞的发生率从3.6%增加到8.8%，冠状动脉内血栓形成的发生率从2.6%增加到5.5%。这与在导丝上频繁观察到血栓物质有关。用尿激酶进行冠状动脉灌注（1670 - 6670 U/分钟）导致并发症发生率进一步增加（10.4%/10.3%/6.5%）。我们目前的PTCA方案（使用PET球囊的单轨技术、硅涂层导丝、不用尿激酶）显示间歇性和复发性冠状动脉闭塞的发生率为3.8%，永久性闭塞的发生率为1.9%。我们怀疑在PTCA引起局部内膜剥离的情况下，纤维蛋白溶解会阻止内膜重新附着于血管壁。我们得出结论，PTCA中冠状动脉内使用尿激酶是一种潜在有害的方案，并且单轨技术应使用硅涂层导丝进行。
