Gallardo A, Pan M, Medina A, Romero M, Melián F, Segura J, Hernández E, Pavlovic D, Ortega J R, del Mar Ciudad M, Morales J, González S, Suárez de Lezo J
Servicio de Cardiología, Hospital Universitario Reina Sofía, Córdoba.
Rev Esp Cardiol. 1996 Apr;49(4):264-9.
Coronary stenoses at ostial level, when treated by balloon angioplasty, show a primary success rate much lower than those located in other parts of the coronary tree. Balloon dilation of lesions located at the left anterior descending ostium is associated with a high degree of restenosis, elastic recoil and the possibility of retrograde dissection to the left main coronary artery. Simpson atherectomy may be considered a percutaneous alternative in this particular location, since this technique produces fewer incidents of elastic recoil than balloon dilation. The purpose of the present study is to evaluate directional atherectomy in the treatment of patients with symptoms deriving from severe to stenosis at the origin of the left anterior descending artery.
From a total number of 302 patients treated by Simpson atherectomy, we have analyzed 45 with severe stenosis at the left anterior descending ostium (less than 3 mm from its origin). The mean age was 54 +/- 12 years. Eighty two percent of the patients were male. The clinical condition was stable in unstable in 34; eleven had had a previous myocardial infarction. Six had multivessel coronary disease, all of them underwent combined balloon angioplasty of other segments. The treated lesion was native in 41 patients and previously dilated by balloon (restenosis) in 4. Two patients needed balloon predilation with 2 and 2.5 mm to facilitate the pass of the atherocatheter. The size of the Simpson atherocatheter was mainly 7F (78%). The weight of the resected arteriosclerotic material was 11 +/- 7 mg.
Primary success (residual stenosis < 40% without major complications) was obtained in 42 out of 45 patients (93%); 3 patients (7%) had major complications (1 death, 1 emergency surgery, and 1 non-Q wave myocardial infarction). A follow-up angiography study was available in 31 patients 7 +/- 8 months later. Restenosis was evidenced in 12 (39%).
Simpson atherectomy for left anterior descending artery ostial lesions is an effective transluminal alternative in selected patients providing a high rate of primary success (93%) and an acceptable restenosis rate (39%).
冠状动脉开口处狭窄在接受球囊血管成形术治疗时，其初始成功率远低于冠状动脉树其他部位的狭窄。位于左前降支开口处的病变进行球囊扩张与高度的再狭窄、弹性回缩以及逆行剥离至左主干冠状动脉的可能性相关。辛普森旋切术在这一特殊部位可被视为一种经皮治疗选择，因为该技术产生的弹性回缩事件少于球囊扩张。本研究的目的是评估定向旋切术治疗因左前降支起始部严重狭窄而出现症状的患者的效果。
在接受辛普森旋切术治疗的302例患者中，我们分析了45例左前降支开口处严重狭窄（距其起始部小于3毫米）的患者。平均年龄为54±12岁。82%的患者为男性。34例患者临床病情稳定，11例不稳定；11例曾有过心肌梗死。6例有多支冠状动脉疾病，均接受了其他节段的联合球囊血管成形术。41例患者的治疗病变为原发，4例先前曾行球囊扩张（再狭窄）。2例患者需要用2毫米和2.5毫米球囊进行预扩张以利于旋切导管通过。辛普森旋切导管的尺寸主要为7F（78%）。切除的动脉硬化物质重量为11±7毫克。
45例患者中有42例（93%）获得初始成功（残余狭窄<40%且无主要并发症）；3例（7%）出现主要并发症（1例死亡、1例急诊手术和1例非Q波心肌梗死）。31例患者在7±8个月后进行了随访血管造影研究。12例（39%）出现再狭窄。
对于左前降支开口处病变，辛普森旋切术是一种有效的腔内治疗选择，在选定患者中初始成功率高（93%）且再狭窄率可接受（39%）。
