Tcheng J E, Wells L D, Phillips H R, Deckelbaum L I, Golobic R A
Department of Medicine, Duke University Medical Center, Durham, North Carolina 27710, USA.
Cathet Cardiovasc Diagn. 1995 Jan;34(1):15-22. doi: 10.1002/ccd.1810340306.
Despite expectations that excimer laser ablation would result in a low incidence of coronary dissection, studies have documented a 15-20% incidence of dissection (including a 4-6% incidence of clinically significant dissection) during excimer interventions. This investigation sought to determine if pressure pulses produced by the exposure of fluid phase media (blood and contrast) to 308-nm excimer radiation might contribute to untoward outcomes. Pressure pulses generated in these media were quantitated to be > 100 atm. In vitro ablation of porcine aorta in the presence of blood or contrast resulted in tissue dissection, while ablation in pure crystalloid did not. Next, a "flush and bathe" technique designed to replace all blood and contrast with crystalloid was applied to a pilot population of 57 consecutive patients. There were no rhythm disturbances or laser-related clinically significant dissections in this group, and the clinical success rate was 95%. In summary, this report quantitates a potential etiology for excimer dissection and suggests that replacement of blood and contrast with crystalloid might improve procedural and clinical success rates.
尽管预期准分子激光消融术会导致冠状动脉夹层的发生率较低，但研究表明，在准分子干预过程中，夹层发生率为15% - 20%（包括4% - 6%具有临床意义的夹层发生率）。本研究旨在确定液相介质（血液和造影剂）暴露于308纳米准分子辐射所产生的压力脉冲是否可能导致不良后果。这些介质中产生的压力脉冲经定量测定超过100个大气压。在有血液或造影剂存在的情况下对猪主动脉进行体外消融会导致组织夹层，而在纯晶体液中消融则不会。接下来，一种旨在用晶体液替代所有血液和造影剂的“冲洗和灌注”技术应用于连续57例患者的试验人群。该组未出现节律紊乱或与激光相关的具有临床意义的夹层，临床成功率为95%。总之，本报告对准分子夹层的潜在病因进行了定量分析，并表明用晶体液替代血液和造影剂可能会提高手术成功率和临床成功率。
