Corcos T, Zimarino M, Tamburino C, Favereau X
Cardiologie Interventionnelle, Centre Médico-Chirurgical Parly-Grand Chesnay, Le Chesnay, France.
Cardiologia. 1993 Dec;38(12 Suppl 1):383-95.
Over the past 16 years coronary angioplasty has become an established therapy for coronary artery disease. Advances in technology and growing operator experience have improved initial success rates, lowered the complications associated with coronary angioplasty and expanded the indications of percutaneous revascularization to include large numbers of patients with complex lesions. The mechanisms of coronary angioplasty include plaque fracture, intimal atherosclerotic flaps, localized medial dissection and stretching of plaque-free segments. The problems and limitations of coronary angioplasty are: unfavourable lesion morphology which may preclude complete revascularization or increase the risk of major complications, "high-risk" patients requiring pharmacological or mechanical support, acute coronary occlusion, and restenosis, the 2 latter problems being related to the very mechanisms of coronary angioplasty. Recently, new interventional devices have been introduced: intracoronary stents, directional coronary atherectomy, rotational atherectomy, transluminal extraction atherectomy, excimer laser coronary angioplasty. A multidevice lesion-specific approach integrated with balloon angioplasty may optimize procedural results in a growing number of patients with complex coronary lesions. However, restenosis occurring within 6 months after successful angioplasty remains the "Achilles' heel" of coronary interventional procedures and erodes the potential advantages angioplasty holds over coronary bypass surgery. These 2 forms of myocardial revascularization are currently compared for the treatment of multivessel disease in randomized trials.
在过去的16年里，冠状动脉血管成形术已成为治疗冠状动脉疾病的一种成熟疗法。技术的进步和术者经验的增加提高了初始成功率，降低了与冠状动脉血管成形术相关的并发症，并扩大了经皮血管重建术的适应证，使其涵盖了大量患有复杂病变的患者。冠状动脉血管成形术的机制包括斑块破裂、内膜动脉粥样硬化瓣、局限性中层剥离以及无斑块节段的伸展。冠状动脉血管成形术的问题和局限性在于：不利的病变形态可能妨碍完全血管重建或增加主要并发症的风险；“高危”患者需要药物或机械支持；急性冠状动脉闭塞；以及再狭窄，后两个问题与冠状动脉血管成形术的机制密切相关。最近，已引入了新的介入装置：冠状动脉内支架、定向冠状动脉斑块旋切术、旋磨术、腔内斑块旋切吸出术、准分子激光冠状动脉血管成形术。一种与球囊血管成形术相结合的针对病变的多装置方法可能会使越来越多患有复杂冠状动脉病变的患者的手术结果达到最佳。然而，成功血管成形术后6个月内发生的再狭窄仍然是冠状动脉介入手术的“阿喀琉斯之踵”，并削弱了血管成形术相对于冠状动脉旁路移植术的潜在优势。目前，在随机试验中正在比较这两种心肌血管重建术治疗多支血管病变的效果。
