Miller M J, Kuntz R E, Friedrich S P, Leidig G A, Fishman R F, Schnitt S J, Baim D S, Safian R D
Charles A. Dana Research Institute, Boston, Massachusetts.
Am J Cardiol. 1993 Mar 15;71(8):652-8. doi: 10.1016/0002-9149(93)91005-3.
Although intimal hyperplasia is a frequent occurrence after arterial interventional procedures, the overall frequency and significance of intimal hyperplasia in primary coronary lesions has not been previously addressed. The incidence of intimal hyperplasia was therefore examined using standard light microscopy in specimens obtained from native coronary arteries of patients undergoing directional coronary atherectomy. The associated clinical history, angiographic results and clinical outcomes were also tabulated. Intimal hyperplasia was identified in 51 of 55 patients (93%) treated with directional coronary atherectomy for restenosis after a prior intervention. These restenosis lesions had less acute gain in lumen diameter after directional coronary atherectomy, a smaller late lumen diameter, more severe late stenosis (p < 0.04), and tended to have more restenosis defined as late stenosis > or = 50% (restenosis rate 40% for prior restenosis vs 26% for primary lesions). Surprisingly, however, intimal hyperplasia was also identified in 45 of 102 (44%) primary stenoses. Primary lesions (n = 45) with intimal hyperplasia were more likely to occur in younger patients and in the left anterior descending artery than were either primary lesions without intimal hyperplasia (n = 57) or prior restenosis lesions. There were otherwise no differences in the baseline characteristics, angiographic findings or clinical outcome of primary lesions with or without intimal hyperplasia (restenosis rate 28 and 24%, respectively). The event-free survival (72% at 12 months) was similar in all 3 groups. Thus, even though intimal hyperplasia is an almost universal finding in restenosis lesions, intimal hyperplasia is not specific for restenosis since histologically identical hyperplasia may be found in nearly half of primary coronary artery stenoses.(ABSTRACT TRUNCATED AT 250 WORDS)
尽管内膜增生在动脉介入术后很常见，但原发性冠状动脉病变中内膜增生的总体发生率及意义此前尚未得到探讨。因此，我们采用标准光学显微镜检查了接受定向冠状动脉斑块旋切术患者的自体冠状动脉标本中的内膜增生情况。同时，还将相关临床病史、血管造影结果及临床转归制成表格。在55例因先前介入治疗后再狭窄而接受定向冠状动脉斑块旋切术的患者中，有51例（93%）发现内膜增生。这些再狭窄病变在定向冠状动脉斑块旋切术后管腔直径的急性增加较小，晚期管腔直径较小，晚期狭窄更严重（p<0.04），并且倾向于有更多定义为晚期狭窄≥50%的再狭窄（先前再狭窄的再狭窄率为40%，而原发性病变为26%）。然而，令人惊讶的是，在102例原发性狭窄中有45例（44%）也发现了内膜增生。与无内膜增生的原发性病变（n=57）或先前再狭窄病变相比，有内膜增生的原发性病变（n=45）更易发生于年轻患者及左前降支。除此之外，有或无内膜增生的原发性病变在基线特征、血管造影表现或临床转归方面并无差异（再狭窄率分别为28%和24%）。三组的无事件生存率（12个月时为72%）相似。因此，尽管内膜增生在再狭窄病变中几乎普遍存在，但内膜增生并非再狭窄所特有，因为在近一半的原发性冠状动脉狭窄中可发现组织学上相同的增生。（摘要截短于250词）
