Roubin G S, Gruentzig A R
Int J Card Imaging. 1985;1(2):143-54. doi: 10.1007/BF01884103.
Current developments in the practice of percutaneous transluminal coronary angioplasty concern increasing the safety of the procedure and reducing the incidence of lesion recurrence. Technical improvements and increased operator experience have greatly expanded the indications for the procedure. With experience, success in dilating proximal discrete lesions is now almost absolute. Old, calcified lesions and chronic total occlusions remain the barriers to total success. Careful case selection and expert anaesthesiology and surgical support are paramount in maintaining low complication rates. The largely unpredictable occurrence of acute vessel reclosure in approximately 2% of patients remains the major problem. This complication is usually the result of uncontrolled intimal dissection. These risks are considerably increased in patients with multivessel and diffuse disease and long lesions. Randomized trials are required to determine if such patients are best managed with bypass graft surgery. Early detection of less advanced coronary disease will ultimately lead to the most effective application of PTCA. Lesion recurrence may be reduced, in part, by careful attention to achieving an optimal, initial arteriographic and haemodynamic result. Otherwise, the solution to restenosis will depend on the development of pharmacological agents which prevent the rapid regrowth of atheromatous plaque.
经皮腔内冠状动脉成形术（PTCA）目前的发展集中在提高手术安全性和降低病变复发率方面。技术的改进以及术者经验的增加极大地拓宽了该手术的适应证。凭借经验，现在扩张近端局限性病变几乎总能成功。陈旧性钙化病变和慢性完全闭塞病变仍是实现完全成功的障碍。仔细的病例选择以及专业的麻醉和外科支持对于维持低并发症发生率至关重要。约2%的患者中急性血管再闭塞的发生很大程度上不可预测，这仍然是主要问题。这种并发症通常是内膜撕裂失控的结果。在多支血管病变、弥漫性病变和长病变患者中，这些风险会显著增加。需要进行随机试验来确定这类患者采用搭桥手术是否为最佳治疗方式。早期发现不太严重的冠状动脉疾病最终将实现PTCA的最有效应用。通过仔细关注以获得最佳的初始血管造影和血流动力学结果，病变复发在一定程度上可能会降低。否则，再狭窄的解决将依赖于能够阻止动脉粥样硬化斑块快速再生的药物的研发。
