Diken Adem Ilkay, Yalçınkaya Adnan, Hanedan Onur, Günertem Eren, Demir Emre, Erol Emir
Hitit University Faculty of Medicine, Cardiovascular Surgery, çamlık caddesi no:2, 19000 çorum, Turkey.
Kardiol Pol. 2017;75(12):1315-1323. doi: 10.5603/KP.a2017.0163. Epub 2017 Aug 23.
The morphology and extensity of the stenotic lesion is crucial as well as the obstruction ratio. It is well known that the complexity of lesions has a direct impact on endovascular treatment (PTCA/stent); however, the arrangement of the lesions is underestimated and not well studied.
We sought to evaluate the haemodynamic effects of different stenotic lesion models and arrangements in vitro.
Vascular circulation was simulated in vitro. Oxygenator, tubing set, polytetrahidroflouroethylene synthetic graft, pressure and flow rate, sensors were used to build the simulation model. Measurements of isolated short, isolated long, identical stenotic tandem short, identical stenotic tandem long, sub-critical long, and critical short lesion combinations were performed and haemodynamic parameters were recorded.
Tandem lesions were more likely to result in critical stenosis comparing single lesions with the same obstruction ratio. This difference became more significant as the obstruction ratio was raised. Tandem long lesions also resulted in more critical stenosis than tandem short lesions. It can be claimed that tandem lesions can result in more flow restriction with reference to single lesions with the same stenotic ratio. Contrary to expectations, tandem short lesions were found to be more stenotic compared with the same degree long individual lesions.
It is effortless to give the decision for simple, discrete and individual lesions, while the ideal decision for long and complicated lesions may remain unclear. Even if these "grey zone" lesions are considered non-critical while investigating them one by one, it must be kept in mind that the overall stenotic effect of these lesions may lead to more haemodynamic impairment.
狭窄病变的形态、范围以及阻塞率都至关重要。众所周知，病变的复杂性对血管内治疗（PTCA/支架）有直接影响；然而，病变的排列方式却被低估且研究不足。
我们试图在体外评估不同狭窄病变模型及排列方式的血流动力学效应。
在体外模拟血管循环。使用氧合器、管路装置、聚四氟乙烯合成移植物、压力和流速传感器构建模拟模型。对孤立短病变、孤立长病变、相同狭窄串联短病变、相同狭窄串联长病变、亚临界长病变和临界短病变组合进行测量，并记录血流动力学参数。
与具有相同阻塞率的单个病变相比，串联病变更易导致临界狭窄。随着阻塞率升高，这种差异变得更加显著。串联长病变比串联短病变导致更严重的临界狭窄。可以认为，与具有相同狭窄率的单个病变相比，串联病变会导致更多的血流受限。与预期相反，发现串联短病变比相同程度的单个长病变更狭窄。
对于简单、离散的单个病变，做出决策很容易，而对于长而复杂的病变，理想的决策可能仍不明确。即使在逐一研究这些“灰色地带”病变时认为它们不严重，但必须牢记这些病变的总体狭窄效应可能导致更严重的血流动力学损害。
