Safian R D, Freed M, Reddy V, Kuntz R E, Baim D S, Grines C L, O'Neill W W
Division of Cardiology, William Beaumont Hospital, Royal Oak, Michigan, 48073, USA.
J Am Coll Cardiol. 1996 Mar 1;27(3):552-9. doi: 10.1016/0735-1097(95)00495-5.
This study sought to determine whether adjunctive balloon angioplasty after rotational atherectomy and excimer laser angioplasty provides better lumen enlargement ("facilitated angioplasty") than angioplasty alone.
Adjunctive angioplasty is often used immediately after atherectomy and laser angioplasty to further enlarge lumen dimensions, but it is not known whether this practice is superior to angioplasty alone.
Balloon angioplasty was performed in 1,266 native coronary lesions alone (n = 541) or after extraction atherectomy (n = 277), rotational atherectomy (Rotablator) (n = 211) or excimer laser angioplasty (n = 237). Quantitative angiographic analysis included final lumen diameter, final diameter stenosis and efficiency of balloon-mediated lumen enlargement.
Compared with angioplasty alone (33 +/- 12% [mean +/- SD]), final diameter stenosis was higher for adjunctive angioplasty after extraction atherectomy (37 +/- 16%, p < 0.001) and excimer laser angioplasty (37 +/- 16%, p < 0.001) and lower after rotational atherectomy (27 +/- 15%, p < 0.001). However, there was significant undersizing of balloons after all three devices. To correct for differences in balloon size, the efficiency index (final lumen diameter/balloon diameter ratio) was calculated and was higher for adjunctive angioplasty after the Rotablator (0.78 +/- 0.14, p < 0.001) than after angioplasty alone (0.69 +/- 0.12). The efficiency indexes suggested facilitated angioplasty after rotational atherectomy for ostial, eccentric, ulcerated and calcified lesions and lesions > 20 mm long. Facilitated angioplasty was also observed after extraction atherectomy and excimer laser angioplasty for ostial lesions, but not for any other lesion subsets.
Rotational atherectomy, extraction atherectomy and excimer laser angioplasty can facilitate the results of balloon angioplasty. However, the extent of facilitated angioplasty is dependent on the device and baseline lesion morphology, consistent with the need for lesion-specific coronary intervention.
本研究旨在确定旋磨术和准分子激光血管成形术后辅助球囊血管成形术是否比单纯血管成形术能提供更好的管腔扩大效果（“易化血管成形术”）。
辅助血管成形术常在旋磨术和激光血管成形术后立即使用，以进一步扩大管腔尺寸，但尚不清楚这种做法是否优于单纯血管成形术。
对1266处原位冠状动脉病变单独进行球囊血管成形术（n = 541），或在旋切术（n = 277）、旋磨术（Rotablator）（n = 211）或准分子激光血管成形术后进行球囊血管成形术（n = 237）。定量血管造影分析包括最终管腔直径、最终直径狭窄率和球囊介导的管腔扩大效率。
与单纯血管成形术（33±12%[均值±标准差]）相比，旋切术后辅助血管成形术（37±16%，p<0.001）和准分子激光血管成形术后辅助血管成形术（37±16%，p<0.001）的最终直径狭窄率更高，而旋磨术后辅助血管成形术的最终直径狭窄率更低（27±15%，p<0.001）。然而，在使用这三种器械后，球囊均存在明显的尺寸过小情况。为校正球囊尺寸差异，计算了效率指数（最终管腔直径/球囊直径比值），旋磨术后辅助血管成形术的效率指数（0.78±0.14，p<0.001）高于单纯血管成形术（0.69±0.12）。效率指数表明，旋磨术后对于开口处、偏心性、溃疡性和钙化性病变以及长度>20 mm的病变，血管成形术更易化。在旋切术和准分子激光血管成形术后，对于开口处病变也观察到了易化血管成形术，但对于其他任何病变亚组均未观察到。
旋磨术、旋切术和准分子激光血管成形术可改善球囊血管成形术的效果。然而，易化血管成形术的程度取决于器械和基线病变形态，这与针对特定病变的冠状动脉介入治疗需求一致。
