Haude M, Erbel R, Issa H, Meyer J
2nd Medical Clinic, Johannes Gutenberg University, Mainz, Germany.
J Am Coll Cardiol. 1993 Jan;21(1):26-34. doi: 10.1016/0735-1097(93)90713-b.
The purpose of this study was to measure elastic recoil from sequential angiograms after balloon angioplasty and after implantation of a balloon-expandable Palmaz-Schatz stent in the same patient, and to compare the results with the late angiographic outcome.
The immediate result of coronary balloon angioplasty is influenced by plastic deformation, primarily of the atherosclerotic plaque, and by elastic recoil, primarily of the less or nondiseased vessel circumference.
The extent of elastic recoil was measured quantitatively as the difference between maximal balloon size and the resulting vessel diameter or cross-sectional area.
Analysis was performed in 60 patients who received a single stent for late restenosis after initially successful coronary balloon angioplasty. Minimal lumen diameter (minimal cross-sectional area) was 0.98 +/- 0.43 mm (0.97 +/- 0.67 mm2) before balloon angioplasty, 2.06 +/- 0.36 mm (3.68 +/- 1.17 mm2) after angioplasty (both p < 0.001 vs. values before angioplasty) and 2.98 +/- 0.26 mm (7.12 +/- 1.28 mm2) after stenting (both p < 0.001 vs. postangioplasty results). No significant changes in vessel reference diameters or areas were measured. Mean balloon/artery ratios were similar in both procedures, ranging from 0.93 to 0.96. The calculated mean elastic recoil was 0.98 +/- 0.50 mm in diameter (31%) and 3.67 +/- 2.05 mm2 in area (48%) after balloon angioplasty compared with 0.10 +/- 0.07 mm (3.5%) and 0.38 +/- 0.36 mm2 (5.1%) after stenting. Increasing balloon sizes induced increased vessel stretch, which was followed by increased elastic recoil in the angioplasty group in contrast to the stenting group. Short, noncalcified and eccentric lesions tend to be associated with increased recoil after balloon angioplasty. Overdilation or underdilation in one of the procedures, changes in postprocedural vasomotion or postprocedural thrombus formation was not responsible for this outcome. After 6 months mean minimal lumen diameter was 2.39 +/- 0.58 mm, suggesting a mean hyperplasia of 0.59 +/- 0.51 mm. Twelve patients (20%) had a follow-up diameter that was equal to or less than the mean postangioplasty result and eight patients (14%) had a diameter stenosis of > 50%.
The implantation of a Palmaz-Schatz stent almost completely eliminates the decrease in vessel dimensions caused by elastic recoil and therefore diminishes the impact of hyperplasia and reduces the rate of restenosis.
本研究旨在测量同一患者在球囊血管成形术后及植入球囊扩张式帕尔马兹 - 施塔茨支架后，通过系列血管造影测量弹性回缩情况，并将结果与后期血管造影结果进行比较。
冠状动脉球囊血管成形术的即刻结果受主要由动脉粥样硬化斑块引起的塑性变形以及主要由病变较轻或无病变的血管圆周引起的弹性回缩影响。
弹性回缩程度通过最大球囊尺寸与最终血管直径或横截面积之间的差值进行定量测量。
对60例最初成功进行冠状动脉球囊血管成形术后因晚期再狭窄而接受单个支架治疗的患者进行了分析。球囊血管成形术前最小管腔直径（最小横截面积）为0.98±0.43毫米（0.97±0.67平方毫米），血管成形术后为2.06±0.36毫米（3.68±1.17平方毫米）（两者与血管成形术前值相比，p均<0.001），支架植入后为2.98±0.26毫米（7.12±1.28平方毫米）（两者与血管成形术后结果相比，p均<0.001）。未测量到血管参考直径或面积有显著变化。两种手术的平均球囊/动脉比值相似，范围为0.93至0.96。计算得出球囊血管成形术后平均弹性回缩直径为0.98±0.50毫米（31%），面积为3.67±2.05平方毫米（48%），而支架植入后分别为0.10±0.07毫米（3.5%）和0.38±0.36平方毫米（5.1%）。球囊尺寸增加导致血管拉伸增加，血管成形术组随后弹性回缩增加，与支架植入组形成对比。短的、非钙化的和偏心病变在球囊血管成形术后往往与回缩增加有关。两种手术中的过度扩张或扩张不足、术后血管运动变化或术后血栓形成均不是导致此结果的原因。6个月后平均最小管腔直径为2.39±0.58毫米，提示平均增生为0.59±0.51毫米。12例患者（20%）随访时的直径等于或小于血管成形术后的平均结果，8例患者（14%）存在直径狭窄>50%。
帕尔马兹 - 施塔茨支架的植入几乎完全消除了由弹性回缩引起的血管尺寸减小，因此减少了增生的影响并降低了再狭窄率。
