Dubois-Rande J L
Service de Cardiologie, Hôpital Henri-Mondor, Créteil.
Ann Cardiol Angeiol (Paris). 1994 Oct;43(8):467-71.
Coronary angioplasty is currently a technique reaching its maturity. The technical perfection of balloons is such that increasingly complex coronary lesions are accessible, with a very high success rate. Approximately 30,000 angioplasties are performed in France each year, France thus being the second country in Europe for the technique. While balloon angioplasty remains the standard technique, many others have developed. Among them, the rotatory auger or rotablator enables the removal of atheroma from the coronary vessel, thereby facilitating, in the case of calcified and complex lesions, the subsequent balloon procedure. Coronary stents have obviously modified the management of complications during angioplasty and lower the incidence of poor results of balloon coronary angioplasty. Extension of the indications of stenting appears to be fairly clear in the context of aortocoronary bypass, but is more open to doubt in the case of primary lesions. However, recent studies appear to suggest better long-term results following stenting. The weak point of these techniques remains restenosis and techniques of the future will be those which provide a perfect immediate result and avoid restenosis later. In this context, massive strides in molecular biology and gene therapy seem to be of major interest.
冠状动脉血管成形术目前是一项已成熟的技术。球囊技术的完善使得越来越复杂的冠状动脉病变能够得到治疗，成功率非常高。法国每年大约进行30000例血管成形术，因此法国是欧洲这项技术的第二大国。虽然球囊血管成形术仍然是标准技术，但也发展出了许多其他技术。其中，旋切钻或旋磨仪能够从冠状动脉血管中清除动脉粥样硬化斑块，从而在钙化和复杂病变的情况下，便于后续的球囊操作。冠状动脉支架显然改变了血管成形术期间并发症的处理方式，并降低了球囊冠状动脉血管成形术效果不佳的发生率。在主动脉冠状动脉搭桥的背景下，支架置入术适应症的扩展似乎相当明确，但在原发性病变的情况下则更值得怀疑。然而，最近的研究似乎表明支架置入术后的长期效果更好。这些技术的弱点仍然是再狭窄，未来的技术将是那些能立即产生完美效果并避免后期再狭窄的技术。在这种背景下，分子生物学和基因治疗的巨大进展似乎备受关注。
