Krajcer Z, Boskovic D, Angelini P, Leatherman L L, Springer A, Leachman R D
Cathet Cardiovasc Diagn. 1982;8(6):553-64. doi: 10.1002/ccd.1810080604.
Transluminal coronary angioplasty (TCA) of the right coronary artery (RCA) was performed by brachial cut-down approach in 33 patients during a period of 16 months. Flexible-tip guiding catheters were used in all cases. TCA was successful in 27 of 33 patients (81%). The stenosis was reduced in successful cases from a mean of 89% predilatation to 26% postdilatation (P less than 0.001). The systolic pressure gradient across the lesion was reduced from a mean of 49 mm Hg to 4 mm Hg (P less than 0.001). Following successful TCA, patients experienced marked improvement in clinical status, functional capacity, and relief of angina. The complication rate in this study was low. There was no early or late mortality. The most common complication was dissection of the coronary artery occurring in four cases (12%). One patient sustained an acute inferior myocardial infarction. Only one patient required emergency coronary artery bypass surgery. The late follow-up (mean 6 months) angiography was obtained in 17 patients. The stenosis recurred in late follow-up in three cases (18%). Our initial experience revealed that the use of softer guiding catheters by brachial technique offers more selective approach for TCA of RCA lesions and provides better results than percutaneous femoral approach with fixed-tip catheters. Our success rate of 81% for dilatation of RCA is significantly higher than previously reported.
在16个月期间，对33例患者经肱动脉切开途径行右冠状动脉（RCA）腔内冠状动脉成形术（TCA）。所有病例均使用软头引导导管。33例患者中有27例（81%）TCA成功。成功病例中狭窄程度从预扩张时的平均89%降至扩张后的26%（P<0.001）。病变处的收缩期压力阶差从平均49mmHg降至4mmHg（P<0.001）。TCA成功后，患者的临床状况、功能能力和心绞痛缓解情况均有显著改善。本研究中的并发症发生率较低。无早期或晚期死亡。最常见的并发症是4例（12%）发生冠状动脉夹层。1例患者发生急性下壁心肌梗死。仅1例患者需要急诊冠状动脉旁路移植术。17例患者进行了晚期随访（平均6个月）血管造影。3例（18%）在晚期随访中出现狭窄复发。我们的初步经验表明，采用肱动脉技术使用较软的引导导管对RCA病变进行TCA可提供更具选择性的方法，并且比使用固定头导管的经皮股动脉途径效果更好。我们对RCA扩张的成功率为81%，显著高于先前报道。
