Noveck H D, Klein L W, Kramer B, Abi-Mansour P, Rosenblum J, Lesch M
Northwestern Memorial Hospital, Chicago, Illinois 60611.
Am J Cardiol. 1989 Nov 1;64(16):980-4. doi: 10.1016/0002-9149(89)90794-7.
Repeat percutaneous transluminal coronary angioplasty (PTCA) for subacute intimal dissections that produce symptoms after a period of 1 month or more is reluctantly performed for fear of extension and abrupt closure. Patients were identified with demonstrated intimal dissections (intimal contrast staining or frank intimal flap) at the time of initial PTCA who returned a mean of 17.5 weeks (range 9 to 50) later with recurrent chest pain. Repeat angiography revealed luminal compromise due to dissection rather than restenosis in 22 patients. Of these, 17 underwent repeat PTCA. Elective bypass surgery without attempted PTCA was chosen in the other 5 patients because of extensive intimal dissections (greater than 2 balloon lengths) or involvement of critical branches. In the group of 17 patients who had repeat PTCA, 10 (group 1) had a frank intimal flap without persistent contrast staining after the initial PTCA, while 7 (group 2) had both persistent staining and a flap. Successful PTCA was performed in 13 of these 17 patients (76%). There were 2 abrupt closures and 2 unsatisfactory luminal openings. One of these patients required urgent coronary bypass surgery. All 10 group 1 patients had successful repeat procedures versus only 3 of 7 group 2 patients (p = 0.01). The 3 patients with the greatest degree of luminal compromise immediately after the initial PTCA had failed repeat PTCA attempts. These results suggest that repeat PTCA for subacute intimal dissections presenting as restenosis can be successfully performed in selected patients, and that the presence of contrast staining and the degree of luminal compromise by the dissection may be predictive of outcome.
对于在1个月或更长时间后出现症状的亚急性内膜夹层，由于担心夹层扩展和突然闭塞，医生往往不情愿进行重复经皮腔内冠状动脉成形术（PTCA）。在初次PTCA时被证实存在内膜夹层（内膜造影剂染色或明显的内膜瓣）的患者，平均在17.5周（9至50周）后因复发性胸痛复诊。重复血管造影显示，22例患者的管腔狭窄是由夹层而非再狭窄所致。其中，17例接受了重复PTCA。另外5例患者因广泛的内膜夹层（超过2个球囊长度）或关键分支受累，选择了不尝试PTCA的择期搭桥手术。在17例接受重复PTCA的患者中，10例（第1组）在初次PTCA后有明显的内膜瓣但无持续的造影剂染色，而7例（第2组）既有持续的染色又有内膜瓣。这17例患者中有13例（76%）PTCA成功。有2例突然闭塞和2例管腔开放不满意。其中1例患者需要紧急冠状动脉搭桥手术。所有10例第1组患者的重复手术均成功，而第2组7例患者中只有3例成功（p = 0.01）。初次PTCA后管腔狭窄程度最大的3例患者重复PTCA尝试失败。这些结果表明，对于表现为再狭窄的亚急性内膜夹层，在选定的患者中可以成功进行重复PTCA，并且造影剂染色的存在和夹层导致的管腔狭窄程度可能预测结果。
