Stack R S, Quigley P J, Collins G, Phillips H R
Interventional Cardiac Catheterization Program, Duke University Medical Center, Durham, North Carolina 27710.
Am J Cardiol. 1988 May 9;61(14):77G-80G. doi: 10.1016/s0002-9149(88)80037-7.
An autoperfusion balloon catheter was developed to allow passive myocardial perfusion during balloon inflation, through a central lumen and multiple side holes in the shaft proximal and distal to the balloon. This report reviews preliminary experimental animal data and initial human clinical experience with this device. In our first study with this device, the duration of inflation in dogs was compared with the maximal duration of inflation using a standard angioplasty catheter. Coronary arteriography was performed to demonstrate distal coronary blood flow through the perfusion balloon catheter. Electrocardiographic recordings and repeated left ventriculograms were performed to detect evidence of ischemia during standard and perfusion and balloon catheter inflations. The average inflation time was 3 +/- 1 minute for the standard catheter and 37 +/- 10 minutes for the perfusion catheter. Each dog had evidence of severe myocardial ischemia during standard inflation, yet none of the animals had ST-segment elevation, ventricular arrhythmia or wall motion abnormality during dilatation with the perfusion catheter. In a second experiment, the effect of prolonged balloon inflations (30 minutes) on intimal hyperplasia was evaluated in the rabbit model. Results of this study showed reduction of intimal and medial hyperplasia after 4 weeks in iliac arteries in rabbits treated with prolonged inflations compared with the contralateral vessel in rabbits treated with standard angioplasty. Initial clinical results from patients treated with this new catheter are presented. The availability of an effective autoperfusion catheter should allow for testing the hypothesis that prolonged inflations could alter the acute angioplasty success rate and long-term restenosis rate.
一种自动灌注球囊导管被研发出来，以便在球囊充盈期间通过位于球囊近端和远端的杆部中央腔和多个侧孔实现被动心肌灌注。本报告回顾了使用该装置的初步实验动物数据和最初的人体临床经验。在我们使用该装置的第一项研究中，将犬类动物的球囊充盈持续时间与使用标准血管成形术导管时的最大充盈持续时间进行了比较。进行冠状动脉造影以显示通过灌注球囊导管的远端冠状动脉血流。在标准充盈、灌注和球囊导管充盈期间进行心电图记录和重复左心室造影，以检测缺血证据。标准导管的平均充盈时间为3±1分钟，灌注导管的平均充盈时间为37±10分钟。在标准充盈期间，每只犬均有严重心肌缺血的证据，但在用灌注导管扩张期间，没有一只动物出现ST段抬高、室性心律失常或室壁运动异常。在第二项实验中，在兔模型中评估了延长球囊充盈（30分钟）对内膜增生的影响。该研究结果显示，与接受标准血管成形术治疗的兔的对侧血管相比，接受延长充盈治疗的兔的髂动脉在4周后内膜和中膜增生减少。本文展示了使用这种新型导管治疗患者的初步临床结果。一种有效的自动灌注导管的出现应该能够检验延长充盈是否会改变急性血管成形术成功率和长期再狭窄率这一假设。
