Ahn Y K, Park J H, Park J S, Lee M K, Jeong M H, Cho J G, Park J C, Kang J C
Department of Internal Medicine, Chonnam University Medical School, Kwangju, Korea.
Korean J Intern Med. 1993 Jan;8(1):15-8. doi: 10.3904/kjim.1993.8.1.15.
Since percutaneous transluminal coronary angioplasty (PTCA) was first introduced in 1977 by Gruentzig as a treatment for proximal short-segmental, non-calcified, concentric isolated coronary stenosis, it has been used with increasing frequency in patients of symptomatic coronary artery disease with broader indications, including patients with multi-vessel disease, unstable angina, acute myocardial infarction and totally occluded coronary arteries. Among these, total coronary occlusion constitutes a subdivision with specific features that require separate evaluation. The purpose of this study was to determine the initial results of PTCA for total coronary occlusion.
Thirty-five patients with manifested ischemic heart disease with totally occluded coronary arteries, documented by coronary angiography, underwent recanalization procedure by PTCA between Jan. 1990 and Oct. 1991.
Thirty-five patients were comprised of 20 acute myocardial infarction (MI), 7 old MI and 8 unstable angina. Eighteen (50.1%) patients had one major atherosclerosis risk factor and 10 (29.4%) had two or more. PTCA for total coronary artery occlusion was attempted in the left anterior descending artery (LAD) in 16 patients, right coronary artery (RCA) in 11, left circumflex artery (LCx) in 2 and protected left main in one. PTCA was successful in 23 patients (66%): LAD in 11/18 (61%) and RCA 11/14 (79%), showing significantly higher success rate with RCA than LAD (p < 0.05). Primary success rate of PTCA in accordance with the duration of the total occlusion estimated on the basis of clinical and angiographic data was 71% (15/21) when less than two weeks, 63% (5/8) when between 2 to 12 weeks, and 50% (3/6) longer than 12 weeks. Mean duration of the total occlusion in successful PTCA was 1.4 months (range; 10 days-5 months) and, 1.7 months (range; 3 weeks-3 years) in failed PTCA. Diameter stenosis of the lesions was significantly decreased from 100% to 19.7% after successful PTCA. There was no death but 2 patients were complicated with coronary artery embolization occluding major distal branches.
The study suggested that PTCA of total coronary artery occlusion can be performed safely and effectively in selected cases and might be more successful in the lesion with shorter duration of occlusion.
自1977年Gruentzig首次引入经皮腔内冠状动脉成形术（PTCA）用于治疗近端短节段、非钙化、同心性孤立性冠状动脉狭窄以来，其在有更广泛适应证的有症状冠状动脉疾病患者中的应用频率不断增加，这些患者包括多支血管病变、不稳定型心绞痛、急性心肌梗死和冠状动脉完全闭塞患者。其中，冠状动脉完全闭塞是一个具有特定特征且需要单独评估的亚组。本研究的目的是确定PTCA治疗冠状动脉完全闭塞的初始结果。
1990年1月至1991年10月期间，35例经冠状动脉造影证实有冠状动脉完全闭塞的缺血性心脏病患者接受了PTCA再通手术。
35例患者包括20例急性心肌梗死（MI）、7例陈旧性MI和8例不稳定型心绞痛。18例（50.1%）患者有一项主要动脉粥样硬化危险因素，10例（29.4%）患者有两项或更多。16例患者尝试在左前降支（LAD）进行冠状动脉完全闭塞的PTCA，11例在右冠状动脉（RCA），2例在左旋支（LCx），1例在左主干保护支。23例（66%）患者PTCA成功：LAD为11/18（61%），RCA为11/14（79%），RCA的成功率显著高于LAD（p<0.05）。根据临床和血管造影数据估计的完全闭塞持续时间，PTCA的初始成功率在闭塞时间少于两周时为71%（15/21），在2至12周时为63%（5/8），超过12周时为50%（3/6）。成功PTCA的完全闭塞平均持续时间为1.4个月（范围：10天至5个月），失败PTCA的为1.7个月（范围：3周至3年）。成功PTCA后病变的直径狭窄从100%显著降至19.7%。无死亡病例，但有2例患者并发冠状动脉栓塞，阻塞主要远端分支。
该研究表明，在选定病例中，冠状动脉完全闭塞的PTCA可以安全有效地进行，并且在闭塞持续时间较短的病变中可能更成功。
