Simpson J B, Selmon M R, Robertson G C, Cipriano P R, Hayden W G, Johnson D E, Fogarty T J
Sequoia Hospital, Redwood City, California.
Am J Cardiol. 1988 May 9;61(14):96G-101G. doi: 10.1016/s0002-9149(88)80040-7.
Sixty-one patients with occlusive peripheral vascular disease were treated with transluminal atherectomy, a catheter-mediated technique for removal of atheroma. The technique was performed using 7Fr, 9Fr or 11Fr atherectomy catheters. Mean percent diameter stenosis was reduced from 71 to 23%, by removal of 831 atheromatous specimens in 949 passes of the cutting element through 136 stenoses in 61 patients. All specimens removed were sent for histopathologic examination to determine the components of the atheroma removed, which differed for specimens removed from original vs restenotic lesions. Percent stenosis was reduced to less than 45% in 118 of 136 stenoses (87%). Complications included 1 thrombus, which resolved after intraarterial infusion of streptokinase and 1 probable distal embolization without sequelae. Three angiographic dissections occurred without impairment of blood flow. There were no instances of acute occlusion, vascular spasm or vessel perforation. Six-month follow-up angiography was performed showing that patients who had a residual stenosis less than 30% after initial atherectomy had a lower restenosis rate (18%) than patients with initial residual stenoses greater than 30% (52%); this result demonstrated the importance of performing more complete atherectomy. Transluminal atherectomy appears to be an effective, predictable and safe method for removing occlusive atheromatous deposits from peripheral arteries.
61例外周血管闭塞性疾病患者接受了腔内斑块旋切术治疗，这是一种通过导管介导去除动脉粥样硬化斑块的技术。该技术使用7F、9F或11F的斑块旋切导管进行。通过在61例患者的136处狭窄病变中，切割元件进行949次操作，去除831个动脉粥样硬化标本，平均狭窄直径百分比从71%降至23%。所有切除的标本均送去进行组织病理学检查，以确定所切除的动脉粥样硬化斑块的成分，从原发病变与再狭窄病变切除的标本成分有所不同。136处狭窄中有118处（87%）狭窄直径百分比降至45%以下。并发症包括1例血栓形成，经动脉内输注链激酶后消退，1例可能的远端栓塞但无后遗症。发生了3例血管造影显示的夹层，但未影响血流。未出现急性闭塞、血管痉挛或血管穿孔的情况。进行了6个月的随访血管造影，结果显示，初始斑块旋切术后残余狭窄小于30%的患者，再狭窄率（18%）低于初始残余狭窄大于30%的患者（52%）；这一结果证明了更彻底地进行斑块旋切术的重要性。腔内斑块旋切术似乎是一种从外周动脉去除闭塞性动脉粥样硬化沉积物的有效、可预测且安全的方法。
