Breisblatt W M, Barnes J V, Weiland F, Spaccavento L J
Cardiology Section, Wilford Hall United States Air Force Medical Center, Lackland Air Force Base, Texas 78236-5300.
J Am Coll Cardiol. 1988 Jun;11(6):1183-90. doi: 10.1016/0735-1097(88)90280-x.
Evaluation of patients with multivessel coronary disease for percutaneous transluminal coronary angioplasty raises the question: Is incomplete revascularization an acceptable procedure in these patients, or does complete revascularization need to be performed, as in coronary artery bypass grafting? To provide an answer the present study utilized exercise thallium imaging as a guide to the performance of angioplasty in 85 patients with multivessel coronary disease. Preangioplasty exercise thallium imaging helped to identify the primary stenosis ("culprit lesion") in 93% of patients. Two weeks to 1 month after dilation of this lesion, repeat thallium imaging identified two patient groups: Group 1, 47 patients with no evidence of ischemia in a second vascular distribution and Group 2, 38 patients with evidence of further angioplasty. In Group 2 47% of patients had angioplasty of a second vessel and 79% required multivessel angioplasty at 1 year follow-up. In contrast, only six Group 1 patients (13%) required angioplasty of a second vessel at 1 year. Thus, incomplete revascularization may be an acceptable approach in many patients with multivessel coronary disease. Stress thallium-201 imaging may be a useful technique in the evaluation and management of these patients.
在这些患者中，不完全血运重建是否是一种可接受的手术方式，还是像冠状动脉旁路移植术那样需要进行完全血运重建？为了给出答案，本研究利用运动铊显像作为指导，对85例多支冠状动脉疾病患者进行血管成形术。血管成形术前的运动铊显像帮助93%的患者识别出主要狭窄（“罪犯病变”）。在该病变扩张后2周至1个月，重复铊显像确定了两个患者组：第1组，47例在另一血管分布区无缺血证据的患者；第2组，38例有进一步血管成形术证据的患者。在第2组中，47%的患者对第二支血管进行了血管成形术，79%的患者在1年随访时需要进行多支血管成形术。相比之下，第1组中只有6例患者（13%）在1年时需要对第二支血管进行血管成形术。因此，不完全血运重建在许多多支冠状动脉疾病患者中可能是一种可接受的方法。负荷铊-201显像在这些患者的评估和管理中可能是一种有用的技术。
