Kimball B P, Cohen E A, Adelman A G
Department of Medicine, Toronto and Mount Sinai Hospitals, Toronto, Ontario, Canada.
J Am Coll Cardiol. 1996 Mar 1;27(3):543-51. doi: 10.1016/0735-1097(95)00511-0.
This study sought to determine whether preprocedural lesion morphology differentially affects the outcome of directional coronary atherectomy versus standard balloon angioplasty.
Despite previous studies (Canadian Coronary Atherectomy Trial [CCAT]/Coronary Angioplasty Verus Excisional Atherectomy Trial [CAVEAT]), directional coronary atherectomy continues to be recommended on the basis of lesion-specific features, although the validity of this approach has never been proved.
A retrospective, subgroup analysis of the CCAT data base (group average +/- SD) was performed.
In the long term (6 months), both procedures were equally successful in the proximal left anterior descending coronary artery (directional atherectomy 0.62 +/- 0.70 mm vs. coronary angioplasty 0.70 +/- 0.72 mm, p = NS), with atherectomy tending to perform best in relatively "simple" lesions (American College of Cardiology/American Heart Association [ACC/AHA] type A: atherectomy 0.57 +/- 0.70 mm vs. angioplasty 0.50 +/- 0.77 mm; ACC/AHA type B1: atherectomy 0.65 +/- 0.68 mm vs. angioplasty 0.60 +/- 0.68 mm) and those with moderate dystrophic calcification (atherectomy 0.79 +/- 0.56 mm vs. angioplasty 0.45 +/- 0.73 mm). Although greatest minimal lumen diameter gains were seen in larger (> 3 mm) coronary arteries (atherectomy 0.76 +/- 0.62 mm vs angioplasty 0.80 +/- 0.72 mm, p = NS) and those with severe obstruction (preprocedural minimal lumen diameter < 1.0 mm: atherectomy 0.80 +/- 0.62 mm vs. angioplasty 0.84 +/- 0.63 mm, p = NS), neither technique was superior, and eccentric stenoses (symmetry index < 0.5) had similar outcomes (atherectomy 0.59 +/- 0.49 mm vs. angioplasty 0.62 +/- 0.65 mm, p = NS).
These data refute many preconceptions regarding the choice of directional coronary atherectomy on the basis of anatomic criteria.
本研究旨在确定术前病变形态是否对定向冠状动脉斑块旋切术与标准球囊血管成形术的结果产生不同影响。
尽管之前有研究（加拿大冠状动脉斑块旋切术试验[CCAT]/冠状动脉血管成形术与切除性斑块旋切术试验[CAVEAT]），但基于病变的特定特征，定向冠状动脉斑块旋切术仍被推荐使用，尽管这种方法的有效性从未得到证实。
对CCAT数据库进行回顾性亚组分析（组均值±标准差）。
从长期来看（6个月），两种手术在左前降支近端冠状动脉中同样成功（定向斑块旋切术为0.62±0.70mm，冠状动脉血管成形术为0.70±0.72mm，p=无显著性差异），斑块旋切术在相对“简单”的病变（美国心脏病学会/美国心脏协会[ACC/AHA] A型：斑块旋切术为0.57±0.70mm，血管成形术为0.50±0.77mm；ACC/AHA B1型：斑块旋切术为0.65±0.68mm，血管成形术为0.60±0.68mm）以及中度营养不良性钙化病变（斑块旋切术为0.79±0.56mm，血管成形术为0.45±0.73mm）中往往表现最佳。尽管在较大（>3mm）冠状动脉（斑块旋切术为0.76±0.62mm，血管成形术为0.80±0.72mm，p=无显著性差异）和严重阻塞病变（术前最小管腔直径<1.0mm：斑块旋切术为0.80±0.62mm，血管成形术为0.84±0.63mm，p=无显著性差异）中观察到最大最小管腔直径增加，但两种技术均无优势，且偏心狭窄（对称指数<0.5）的结果相似（斑块旋切术为0.59±0.49mm，血管成形术为0.62±0.65mm，p=无显著性差异）。
这些数据驳斥了许多基于解剖学标准选择定向冠状动脉斑块旋切术的先入之见。
