Hering D, Haude M, Caspari G, Baumgart D, Erbel R
Abteilung für Innere Medizin mit Schwerpunkt Kardiologie und Pulmologie, Universitätsklinik Benjamin Franklin Freie Universität Berlin.
Z Kardiol. 1996 Apr;85(4):273-80.
In this study, we examined whether percutaneous coronary angioplasty (PTCA) of native coronary arteries with high inflation pressure can improve the immediate postinterventional result in comparison to PTCA with nominal inflation pressure. Using quantitative coronary angiography, we analyzed the coronary angiograms of 24 patients who underwent PTCA with nominal inflation pressure (< 10 atm; group 1) and of 20 patients who underwent PTCA with high inflation pressure (> or = 10 atm; group 2). Only balloon catheters with little compliance were used. The following variables were recorded: 1) minimal luminal diameter (MLD), reference diameter and percent diameter stenosis before and after PTCA, 2) average balloon diameter during PTCA, 3) balloon/artery diameter ratio, 4) acute luminal gain (difference between MLD before and after PTCA), 5) nominal elastic recoil (difference between nominal balloon diameter and MLD after PTCA), 6) actual elastic recoil (difference between average balloon diameter during PTCA and MLD after PTCA). Nominal balloon diameter, reference diameter before and after PTCA and the balloon/artery diameter ratio were similar in both groups. Application of high inflation pressure resulted in a greater average balloon diameter. In group 2 (high inflation pressure), average balloon diameter amounted to 94 +/- 12% of nominal balloon diameter, whereas in group 1 (nominal inflation pressure), it reached only 84 +/- 9% of nominal balloon diameter. Actual elastic recoil was not different between the two groups. Nominal elastic recoil, however, was greater in the cohort which received PTCA with nominal inflation pressure (1.13 +/- 0.35 mm vs. 0.83 +/- 0.28 mm; p < 0.02). After use of high inflation pressure, acute postinterventional luminal gain was significantly increased (1.04 +/- 0.25 mm vs. 0.77 +/- 0.34 mm; p < 0.02) and the postinterventional percent diameter stenosis was significantly lower (12 +/- 10% vs. 24 +/- 13%; p < 0.05). Application of high inflation pressure improves the postinterventional result after PTCA because of a greater acute luminal gain. The stenotic coronary artery is expanded to a greater degree, and actual elastic recoil remains unchanged.
在本研究中，我们探讨了对天然冠状动脉进行高压力球囊扩张的经皮冠状动脉腔内血管成形术（PTCA）与采用标准压力球囊扩张的PTCA相比，能否改善介入术后的即时效果。我们使用定量冠状动脉造影分析了24例行标准压力球囊扩张（<10个大气压；第1组）和20例行高压力球囊扩张（≥10个大气压；第2组）的PTCA患者的冠状动脉造影图像。仅使用顺应性小的球囊导管。记录了以下变量：1）PTCA前后的最小管腔直径（MLD）、参考直径和直径狭窄百分比；2）PTCA期间的平均球囊直径；3）球囊/动脉直径比；4）急性管腔增加量（PTCA前后MLD的差值）；5）标准弹性回缩（标准球囊直径与PTCA后MLD的差值）；6）实际弹性回缩（PTCA期间平均球囊直径与PTCA后MLD的差值）。两组的标准球囊直径、PTCA前后的参考直径以及球囊/动脉直径比相似。高压力球囊扩张导致平均球囊直径更大。在第2组（高压力球囊扩张）中，平均球囊直径达标准球囊直径的94±12%，而在第1组（标准压力球囊扩张）中，仅为标准球囊直径的84±9%。两组间实际弹性回缩无差异。然而，采用标准压力球囊扩张的队列中标准弹性回缩更大（1.13±0.35毫米对0.83±0.28毫米；p<0.02）。使用高压力球囊扩张后，介入术后急性管腔增加量显著增加（1.04±0.25毫米对0.77±0.34毫米；p<0.02），介入术后直径狭窄百分比显著降低（12±10%对24±13%；p<0.05）。由于急性管腔增加量更大，高压力球囊扩张可改善PTCA术后的效果。狭窄的冠状动脉扩张程度更大，且实际弹性回缩保持不变。
