Schwarcz T H, Dobrin P B, Mrkvicka R, Skowron L, Cole M B
Department of Surgery, Loyola University Medical Center, Maywood, Ill.
J Vasc Surg. 1988 Apr;7(4):495-9. doi: 10.1067/mva.1988.avs0070495.
Arterial stenosis occurring after balloon catheter embolectomy may be caused by myointimal hyperplasia (MIH). This study investigated the effects of shear force and repeated catheter withdrawals on the development of MIH after embolectomy. The procedures were performed in the common carotid and common femoral arteries of 18 anesthetized dogs. During catheter withdrawal, the balloons were filled gradually to produce shear forces rising smoothly from 50 to 200 gm. Four weeks after embolectomy, the vessels were perfusion-fixed in situ with 2% glutaraldehyde and were excised. The thickness and circumferential extent of MIH were measured in cross sections from segments of the vessels exposed to shear forces of 50, 100, and 200 gm. Sixty-nine of 72 arteries remained patent. Low shear force (50 gm) consistently elicited less MIH than did higher shear forces (p less than 0.05). At each level of shear force, repeated withdrawals resulted in greater circumferential extent of MIH than did single withdrawals (p less than 0.005). Although clinically it usually is necessary to perform multiple passes during balloon embolectomy, these data suggest that, in humans, attempts should be made to perform a minimal number of catheter withdrawals at low shear force to minimize the subsequent development of MIH.
球囊导管取栓术后发生的动脉狭窄可能由肌内膜增生（MIH）引起。本研究调查了剪切力和反复回撤导管对取栓术后MIH发生发展的影响。实验操作在18只麻醉犬的颈总动脉和股总动脉中进行。在回撤导管过程中，球囊逐渐充盈以产生从50克平稳上升至200克的剪切力。取栓术后四周，血管在原位用2%戊二醛进行灌注固定，然后切除。在暴露于50克、100克和200克剪切力的血管节段的横切面上测量MIH的厚度和周向范围。72条动脉中有69条保持通畅。低剪切力（50克）引起的MIH始终少于较高剪切力（p<0.05）。在每个剪切力水平下，反复回撤比单次回撤导致MIH的周向范围更大（p<0.005）。虽然临床上在球囊取栓术中通常需要多次操作，但这些数据表明，对于人类而言，应尝试在低剪切力下进行最少次数的导管回撤，以尽量减少MIH的后续发展。
