Grüntzig A R, Senning A, Siegenthaler W E
N Engl J Med. 1979 Jul 12;301(2):61-8. doi: 10.1056/NEJM197907123010201.
In percutaneous transluminal coronary angioplasty, a catheter system is introduced through a systemic artery under local anesthesia to dilate a stenotic artery by controlled inflation of a distensible balloon. Over the past 18 months, we have used this technic in 50 patients. The technic was successful in 32 patients, reducing the stenosis from a mean of 84 to 34 per cent (P less than 0.001) and the coronary-pressure gradient from a mean of 58 to 19 mm Hg (P less than 0.001). Twenty-nine patients showed improvement in cardiac function during follow-up examination. Because of acute deterioration in clinical status, emergency bypass was later necessary in five patients; three showed electrocardiographic evidence of infarcts. Patients with single-vessel disease appear to be most suitable for the procedure, and a short history of pain indicates the presence of a soft (distensible) atheroma likely to respond to dilatation. We estimate that only about 10 to 15 per cent of candidates for bypass surgery have lesions suitable for this procedure. A prospective randomized trial will be necessary to evaluate its usefulness in comparison with surgical and medical management.
在经皮腔内冠状动脉成形术中，通过局部麻醉经体动脉插入导管系统，通过可控地充盈可扩张球囊来扩张狭窄动脉。在过去18个月中，我们已在50例患者中应用了该技术。该技术在32例患者中取得成功，使狭窄率从平均84%降至34%（P<0.001），冠状动脉压力梯度从平均58 mmHg降至19 mmHg（P<0.001）。29例患者在随访检查期间心功能有所改善。由于临床状况急性恶化，5例患者后来需要进行急诊搭桥手术；3例有心电图梗死证据。单支血管病变的患者似乎最适合该手术，疼痛病史短表明存在可能对扩张有反应的软性（可扩张）动脉粥样硬化斑块。我们估计，只有约10%至15%的搭桥手术候选者有适合该手术的病变。需要进行一项前瞻性随机试验，以评估其与手术和药物治疗相比的有效性。
