Zalewski A, Savage M, Goldberg S
Department of Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania.
Am J Cardiol. 1988 May 9;61(14):54G-60G. doi: 10.1016/s0002-9149(88)80033-x.
Therapeutic balloon coronary angioplasty provides a useful model for studying the effects of epicardial coronary artery occlusion in conscious humans. In addition, it is a potent model in which the effectiveness of interventions designed to ameliorate ischemia can be evaluated. Whereas intravenous beta-adrenergic blocking drugs and nitrates appear to have a limited protective effect, the regional (i.e., intracoronary) use of beta-adrenergic blocking drugs and calcium antagonists seem more potent. Currently, coronary venous retroperfusion with arterial blood does not appear practical, and the intraaortic balloon is a useful adjunctive measure in relatively few patients undergoing percutaneous transluminal coronary angioplasty. In contrast, the direct anterograde delivery of oxygen-rich blood or fluorocarbons holds promise as a reliable means of providing local myocardial protection. If ischemia could be markedly reduced, percutaneous transluminal coronary angioplasty might be applied safely in more high-risk clinical settings. In addition, if prolonged balloon inflation could be performed, there might be an increase in primary success rate and possibly a reduction in restenosis rate.
治疗性球囊冠状动脉成形术为研究清醒人体心外膜冠状动脉闭塞的影响提供了一个有用的模型。此外，它还是一个有力的模型，在该模型中可以评估旨在改善缺血的干预措施的有效性。虽然静脉注射β-肾上腺素能阻滞剂和硝酸盐似乎具有有限的保护作用，但局部（即冠状动脉内）使用β-肾上腺素能阻滞剂和钙拮抗剂似乎更有效。目前，用动脉血进行冠状静脉逆行灌注似乎不切实际，主动脉内球囊在接受经皮腔内冠状动脉成形术的相对较少患者中是一种有用的辅助措施。相比之下，直接顺行输送富氧血液或氟碳化合物有望成为提供局部心肌保护的可靠手段。如果缺血能够显著减少，经皮腔内冠状动脉成形术可能可以在更多高风险临床情况下安全应用。此外，如果能够进行长时间的球囊充盈，可能会提高一次成功率，并有可能降低再狭窄率。
