Cherrier F, Cuillère M, Monassier J P, Aliot E, Villemot J P
Arch Mal Coeur Vaiss. 1984 Mar;77(3):235-44.
Between April 1980 and November 1982, 120 patients underwent transluminal coronary angioplasty (TCA) by Gruntzig's technique (128 attempts on 132 vessels). Immediate results were evaluated by: the transstenotic pressure gradient (disappearance of a systolic gradient, mean residual gradient less than 15 mmHg); angiographic improvement (at least 25 p. 100) with less than 50 p. 100 residual stenosis. Success was confirmed by symptomatic and electrocardiographic improvement, the comparison of radio-isotopic studies (Thallium myocardial scintigraphy or tomography; global and regional left ventricular contractility by Technetium radioangiography) at rest and if possible during exercise before TCA and 2 and 6 months after TCA. The incidence of primary success was 72 p. 100 (stable angina: 67,2 p. 100, unstable angina 79,4 p. 100 NS); recurrence was observed in 16/69 of controlled patients (23,1 p. 100); 7 secondary TCA were performed with 5 successful results, leaving 16 p. 100 "permanent" recurrences in this series. There were 2 deaths (1 electromechanical dissociation, 1 rupture of the balloon with dissection due to dysfunction of a new manometer), 5 rudimentary infarcts (transient Q waves and/or slight enzymatic elevation), 6 infarcts (5 anterior, 1 posterior), 4 acute coronary insufficiencies (total regression after surgery). There were 11 immediate (9 as an emergency) and 9 secondary aorto-coronary bypass operations. There were 2 femoral artery repair procedures.
certain technical procedures are relatively easy; successive utilisation of a 2 then a 3,7 mm balloon in severe or excentric stenoses for instance. Nine stenoses became occluded without infarction between coronary angiography and the TCA procedures: 2 were recanalised by the guide wire (and then dilated). Therefore, in very severe stenoses TCA should be performed rapidly, even straight away. TCA is associated with some risk to the patient: experienced operators and immediate surgical cover are essential. Initial evaluation of results should be careful: measurement of the pressure gradient is often erroneous (damping of pressure wave, transmission of ventricular pressure); automatic measurements show an overestimation of the degree of stenosis of more than 60 p. 100. Stress radioisotopic studies seem to be the most satisfactory way of assessing the outcome. Medium term results are encouraging: the majority of patients return to work, but this took too long. The ideal theoretical indication remains rare.(ABSTRACT TRUNCATED AT 400 WORDS)
1980年4月至1982年11月期间，120例患者采用格伦齐格技术接受了经皮腔内冠状动脉成形术（TCA）（对132支血管进行了128次尝试）。通过以下指标评估即刻结果：跨狭窄压力梯度（收缩期梯度消失，平均残余梯度小于15 mmHg）；血管造影改善（至少25%），残余狭窄小于50%。通过症状和心电图改善、静息状态下以及尽可能在TCA术前、术后2个月和6个月运动时进行放射性同位素研究（铊心肌闪烁显像或断层扫描；锝放射性血管造影评估左心室整体和局部收缩功能）的比较来确认成功。初次成功率为72%（稳定型心绞痛：67.2%，不稳定型心绞痛79.4%，无显著性差异）；在69例接受对照的患者中有16例复发（23.1%）；进行了7次二次TCA，5次成功，该系列中有16%为“永久性”复发。有2例死亡（1例电机械分离，1例因新型压力计功能障碍导致球囊破裂并伴有夹层），5例微小梗死（短暂Q波和/或轻度酶升高），6例梗死（5例前壁，1例后壁），4例急性冠状动脉供血不足（术后完全缓解）。有11例即刻（9例为急诊）和9例二次主动脉 - 冠状动脉搭桥手术。有2例股动脉修复手术。
某些技术操作相对容易；例如，在严重或偏心狭窄中先后使用2mm然后3.7mm的球囊。在冠状动脉造影和TCA操作之间有9处狭窄闭塞但未发生梗死：2处通过导丝再通（然后扩张）。因此，在非常严重的狭窄中应迅速进行TCA，甚至立即进行。TCA对患者有一定风险：需要经验丰富的操作人员和即刻的手术保障。对结果的初步评估应谨慎：压力梯度测量常常有误（压力波衰减、心室压力传导）；自动测量显示对狭窄程度的高估超过60%。负荷放射性同位素研究似乎是评估结果最令人满意的方法。中期结果令人鼓舞：大多数患者恢复工作，但所需时间过长。理想的理论适应证仍然很少见。（摘要截断于400字）
