Horner S M
Department of Cardiology, Middlesex Hospital, London, England.
Jpn Heart J. 1993 Nov;34(6):685-91. doi: 10.1536/ihj.34.685.
Percutaneous transluminal coronary angioplasty of coronary artery occlusions forms a routine part of cardiological practice. However, only a few angiographic variables which might predict success have been investigated and identified. Video densitometry was used to assess structural features of the occlusion that have not been investigated previously. The sharpness and eccentricity of the tapering, the presence of any distal vessel and the presence of a reservoir or atrium in which the end of the wire could become trapped were measured. Other measurements taken from the cineangiogram included the minimum radius of curvature of the artery immediately before the occlusion, the number of bends and the distance traversed before the occlusion. The number, size, location and angle of branching of side branches from the artery in question were noted. The number of bridging collaterals and presence of distal opacification were noted. There was a significantly higher success rate in patients with less than 3 bends before the occlusion (p = 0.01) and a distance down the artery to the occlusion of less than 27 mm (p < 0.05). An atrium was present in 36% and was associated with an unsuccessful outcome (p = 0.02). Distal opacification, despite occlusion of the artery, was found to be associated with failure to cross the lesion (p < 0.05). The angle of branches of the artery was only found to be important near (within 7.5 mm) the occlusion (p < 0.05). None of the video densitometric measurements of the fine structure of the stump of the coronary artery were found to be helpful.
经皮腔内冠状动脉成形术治疗冠状动脉闭塞是心脏病学实践中的常规操作。然而，仅有少数可能预测手术成功的血管造影变量得到了研究和确认。视频密度测定法用于评估此前未被研究过的闭塞结构特征。测量了狭窄段的尖锐度和偏心度、有无远端血管以及是否存在导丝末端可能被困的贮液池或心房。从电影血管造影中获取的其他测量数据包括闭塞前紧邻动脉处的最小曲率半径、弯曲数量以及闭塞前的走行距离。记录了相关动脉侧支的数量、大小、位置和分支角度。记录了桥接侧支的数量和远端造影剂充盈情况。闭塞前弯曲少于3处的患者成功率显著更高（p = 0.01），动脉至闭塞处的距离小于27 mm的患者成功率也显著更高（p < 0.05）。36%的患者存在心房，且与手术失败相关（p = 0.02）。尽管动脉闭塞，但发现远端造影剂充盈与未能穿过病变相关（p < 0.05）。仅在闭塞附近（7.5 mm范围内）发现动脉分支角度具有重要意义（p < 0.05）。未发现冠状动脉残端精细结构的视频密度测量指标有任何帮助。
