Hombach V, Waltenberger J, Voisard R, Höher M
Z Kardiol. 1995 Jan;84(1):5-21.
Percutaneous transluminal coronary angioplasty by balloon dilatation (PTCA) has proved to be the standard procedure for non-operative removal of coronary artery stenoses. Since the initial description and application by Andreas Grüntzig, the results of this procedure are excellent with an acute success rate of 90-96%, a rate of severe acute complications of 1% and less, and a procedure-related death rate below 1%, mainly due to considerable technical improvements and greater experience of the interventional cardiologists. On the other hand, the restenosis rate following PTCA could not be significantly lowered. In recent years a number of alternative angioplasty devices has been developed aimed at-among other indications-reducing the restenosis rate following PTCA by a "less traumatic" vessel angioplasty. These include radiofrequency angioplasty (RFCA), high frequency rotational angioplasty (HFRCA), excimer-laser angioplasty (ELCA), directional atherectomy (DCA), as well as implantation of intravascular stents. Based on more or less extensive experiences from the literature, the aim at lowering the recurrency rate by the latter procedures has been missed, despite the fact that particularly ELCA and HFRCA were used to reduce stenoses in lesions unsuitable for balloon catheter dilatation. There is a trend of lowering the recurrence rate with the implantation of coronary stents. The benefit of this procedure, however, is at the expense of an increased rate of acute stent thrombosis and by local acute bleeding problems quite often requiring surgical repair. The cellular biological mechanisms following balloon angioplasty are only partially understood. Among these are a number of interactive processes like cell adhesion, coagulation, vascular contraction, cell migration, cell proliferation, and synthesis of extracellular matrix. In this respect, migration and proliferation of smooth muscle cells represent a key process for the development of restenosis. In addition, endothelial denudation represents a stimulus for migration and proliferation of smooth muscle cells. Rapid and efficient reendothelialization may counteract this process. Recent progress of modern biology has provided new concepts and methodological tools for the molecular analysis of vascular remodeling. It has been shown that specialized cellular functions such as proliferation, migration, and production of extracellular matrix can be mediated by growth factors such as platelet-derived growth factor (PDGF), basic fibroblast growth factor (bFGF) or transforming growth factor-beta (TGF-beta).(ABSTRACT TRUNCATED AT 400 WORDS)
经皮腔内冠状动脉球囊扩张成形术（PTCA）已被证明是一种非手术去除冠状动脉狭窄的标准方法。自安德烈亚斯·格鲁恩齐格首次描述并应用以来，该手术效果极佳，急性成功率达90% - 96%，严重急性并发症发生率为1%及以下，与手术相关的死亡率低于1%，这主要得益于技术上的显著改进以及介入心脏病专家经验的丰富。另一方面，PTCA术后的再狭窄率并未显著降低。近年来，已研发出多种替代血管成形术器械，旨在通过“创伤较小”的血管成形术等方法降低PTCA术后的再狭窄率。这些器械包括射频血管成形术（RFCA）、高频旋磨术（HFRCA）、准分子激光血管成形术（ELCA）、定向斑块旋切术（DCA）以及血管内支架植入术。基于文献中或多或少的广泛经验，尽管特别使用ELCA和HFRCA来减少不适用于球囊导管扩张的病变中的狭窄，但通过后几种手术降低复发率的目标并未实现。植入冠状动脉支架有降低复发率的趋势。然而，该手术的益处是以急性支架血栓形成率增加以及经常需要手术修复的局部急性出血问题为代价的。球囊血管成形术后的细胞生物学机制仅被部分理解。其中包括许多相互作用的过程，如细胞黏附、凝血、血管收缩、细胞迁移、细胞增殖以及细胞外基质的合成。在这方面，平滑肌细胞的迁移和增殖是再狭窄发生的关键过程。此外，内皮剥脱是平滑肌细胞迁移和增殖的刺激因素。快速有效的内皮再形成可抵消这一过程。现代生物学的最新进展为血管重塑的分子分析提供了新的概念和方法工具。已表明，诸如增殖、迁移和细胞外基质产生等特定细胞功能可由血小板衍生生长因子（PDGF）、碱性成纤维细胞生长因子（bFGF）或转化生长因子-β（TGF-β）等生长因子介导。
