Violaris A G, Melkert R, Herrman J P, Serruys P W
Catheterization Laboratory, Thoraxcenter, Erasmus University, Rotterdam, The Netherlands.
Circulation. 1996 Mar 1;93(5):889-97. doi: 10.1161/01.cir.93.5.889.
Experimental studies suggest that mural thrombus may be involved in postangioplasty restenosis. The aim of our study was to examine the role of angiographically identifiable thrombus in the clinical situation.
The study population comprised 2950 patients (3583 lesions). The presence of angiographically identifiable thrombus either before or after the procedure was defined as the presence of a generalized haziness or filling defect within the arterial lumen. Restenosis was assessed by both a categorical (> 50% diameter stenosis at follow-up) and a continuous approach (absolute and relative losses). The study population included 160 lesions with and 3423 lesions without angiographically identifiable thrombus. The categorical restenosis rate was significantly higher in lesions containing angiographically identifiable thrombus: 43.1% versus 34.4%, P < .01; relative risk, 1,449; CI, 1.051 to 1.997. The absolute and relative losses were also higher in lesions containing angiographically identifiable thrombus (absolute loss, 0.43 +/- 0.66 versus 0.32 +/- 0.52; relative loss, 0.16 +/- 0.26 versus 0.13 +/- 0.21; both P < .05). The higher restenosis in these lesions was due primarily to an increased incidence of occlusion at follow-up angiography in this group: 13.8% versus 5.7%, P < .001. When lesions that went on to occlude by the time of follow-up angiography were excluded from the analysis, the restenosis rate between the two groups was similar by both the categorical (34.1% versus 30.4%, P=NS; relative risk, 1.183; CI, 0.824 to 1.696) and continuous (absolute loss, 0.23 +/- 0.46 versus 0.24 +/- 0.42, P=NS; relative loss, 0.09 +/- 0.17 versus 0.09 +/- 0.16, P=NS) approaches.
Our results indicate that the presence of angiographically identifiable thrombus at the time of the angioplasty is associated with higher restenosis. The mechanism by which this occurs is through vessel occlusion at follow-up angiography. Measures aimed at improving outcome in this group of patients should be focused in this direction.
实验研究表明，壁血栓可能与血管成形术后再狭窄有关。我们研究的目的是在临床情况下检验血管造影可识别血栓的作用。
研究人群包括2950例患者（3583处病变）。血管造影可识别血栓在手术前或手术后的存在被定义为动脉腔内存在弥漫性模糊或充盈缺损。通过分类法（随访时直径狭窄>50%）和连续法（绝对和相对损失）评估再狭窄。研究人群包括160处有血管造影可识别血栓的病变和3423处无血管造影可识别血栓的病变。有血管造影可识别血栓的病变的分类再狭窄率显著更高：43.1%对34.4%，P<.01；相对风险，1.449；置信区间，1.051至1.997。有血管造影可识别血栓的病变的绝对和相对损失也更高（绝对损失，0.43±0.66对0.32±0.52；相对损失，0.16±0.26对0.13±0.21；两者P<.05）。这些病变中较高的再狭窄主要是由于该组随访血管造影时闭塞发生率增加：13.8%对5.7%，P<.001。当将随访血管造影时已闭塞的病变排除在分析之外时，两组之间的再狭窄率通过分类法（34.1%对30.4%，P=无显著性差异；相对风险，1.183；置信区间，0.824至1.696）和连续法（绝对损失，0.23±0.46对0.24±0.42，P=无显著性差异；相对损失，0.09±0.17对0.09±0.16，P=无显著性差异）均相似。
我们的结果表明血管成形术时血管造影可识别血栓的存在与较高的再狭窄相关。发生这种情况的机制是随访血管造影时血管闭塞。旨在改善该组患者预后的措施应朝这个方向聚焦。
