Douglas J S, King S B, Roubin G S
Am J Cardiol. 1987 Jul 31;60(3):29B-33B. doi: 10.1016/0002-9149(87)90480-2.
Restenosis after percutaneous transluminal coronary angioplasty (PTCA) remains the principal factor preventing broader application of this form of myocardial revascularization. Several methodologic variables contribute to the quality of the angioplasty result and may directly or indirectly influence restenosis rates after the procedure. PTCA operators attempt to minimize thrombotic activity at the angioplasty site by delaying PTCA when thrombus is present, with heparin and antiplatelet agents and with thrombolytic agents if thrombus is identified during the procedure. Therapy directed at preventing coronary artery spasm with nitrates and calcium antagonists has no proven efficacy in preventing restenosis. Residual stenosis and pressure gradient have been shown to be predictors of restenosis. Retrospective studies have indicated that a balloon to artery diameter ratio greater than 1 favors long-term patency; however, preliminary results of a prospective randomized study suggested that acute complications were more frequent with larger balloons. The interplay of other balloon-related variables (maximal inflation pressure, number of inflations, duration of inflations, balloon material and length of balloon) and the potential influence on restenosis are discussed. Recommendations for patient management after PTCA are also offered. A number of prospective randomized trials using antiplatelet agents and modification of risk factors are underway to test ability of these strategies to influence restenosis.
经皮腔内冠状动脉成形术（PTCA）后的再狭窄仍然是阻碍这种心肌血运重建形式更广泛应用的主要因素。若干方法学变量会影响血管成形术的结果质量，并可能直接或间接影响术后的再狭窄率。PTCA操作人员会在存在血栓时推迟PTCA，使用肝素和抗血小板药物，以及在操作过程中发现血栓时使用溶栓药物，试图将血管成形术部位的血栓形成活动降至最低。使用硝酸盐和钙拮抗剂预防冠状动脉痉挛的治疗方法在预防再狭窄方面尚未证实有效。残余狭窄和压力梯度已被证明是再狭窄的预测指标。回顾性研究表明，球囊与动脉直径比大于1有利于长期通畅；然而，一项前瞻性随机研究的初步结果表明，使用较大球囊时急性并发症更常见。文中讨论了其他与球囊相关的变量（最大膨胀压力、膨胀次数、膨胀持续时间、球囊材料和球囊长度）之间的相互作用以及对再狭窄的潜在影响。还提供了PTCA术后患者管理的建议。一些使用抗血小板药物和改变危险因素的前瞻性随机试验正在进行中，以测试这些策略影响再狭窄的能力。
