Haude M, Caspari G, Baumgart D, Brennecke R, Meyer J, Erbel R
Cardiology Department, University of Essen, Germany.
Circulation. 1996 Aug 1;94(3):286-97. doi: 10.1161/01.cir.94.3.286.
Stents provide a scaffold for coronary arteries after angioplasty and inhibit elastic recoil.
In 25 patients with postangioplasty restenosis of the left anterior descending artery, ECG-gated digital subtraction coronary angiograms were recorded at baseline and during hyperemia (12 mg papaverine IC) before and after balloon predilatation (PTCA), after implantation of a Palmaz-Schatz stent, and after 6 months. Densitometric evaluation revealed different time and density parameters to calculate two definitions of myocardial perfusion reserve (MPR1 and MPR2) and maximum flow ratio (MaxFR). Poststenotic MPR1 increased from 1.57 +/- 0.14 to 2.59 +/- 0.86 after PTCA and to 3.10 +/- 0.41 after stenting, with 2.90 +/- 0.65 at follow-up (ANOVA, P < .05), while reference MPR1 remained unchanged at 3.10 +/- 0.40. Poststenotic MPR2 increased from 1.36 +/- 0.28 to 2.50 +/- 1.20 and to 3.40 +/- 0.58, respectively, with 3.20 +/- 0.92 at follow-up (ANOVA, P < .05), while reference MPR2 remained unchanged at 3.40 +/- 0.60. MaxFR was 2.13 +/- 0.53 after PTCA, elasticity 2.83 +/- 0.35 after stenting, and 2.73 +/- 0.58 at follow-up (ANOVA, P < .05). A good correlation was found between minimal stenotic luminal diameter and MPR1 or MPR2 (r = .87 and r = .94) and between luminal gain and MaxFR (r = .75). A negative correlation was measured between recoil and MPR1, MPR2, and MaxFR (r = -.80, r = -.86, and r = -.83). At follow-up, a steeper correlation was found between MPR and minimal stenosis diameter (MPR1: slope, 0.52 versus 0.91; MPR2: slope, 1.48 versus 1.95) and between MaxFR and net lumen gain (slope, 0.78 versus 1.27).
Coronary stent implantation in patients with postangioplasty restenosis normalized poststenotic myocardial perfusion immediately as a result of a larger postprocedural lumen and a more pronounced inhibition of elastic recoil. After 6 months this benefit was sustained despite progressive lumen loss.
支架为血管成形术后的冠状动脉提供支架结构并抑制弹性回缩。
对25例左前降支血管成形术后再狭窄患者，在基线时、球囊预扩张（PTCA）前后、植入Palmaz-Schatz支架后及6个月时，记录心电图门控数字减影冠状动脉造影。密度测定评估显示，计算心肌灌注储备（MPR1和MPR2）和最大血流比（MaxFR）的两种定义有不同的时间和密度参数。狭窄后MPR1在PTCA后从1.57±0.14增加到2.59±0.86，支架植入后增加到3.10±0.41，随访时为2.90±0.65（方差分析，P<.05），而参照MPR1保持不变，为3.10±0.40。狭窄后MPR2分别从1.36±0.28增加到2.50±1.20和3.40±0.58，随访时为3.20±0.92（方差分析，P<.05），而参照MPR2保持不变，为3.40±0.60。PTCA后MaxFR为2.13±0.53，支架植入后弹性为2.83±0.35，随访时为2.73±0.58（方差分析，P<.05）。最小狭窄管腔直径与MPR1或MPR2之间（r=.87和r=.94）以及管腔增益与MaxFR之间（r=.75）发现有良好的相关性。回缩与MPR1、MPR2和MaxFR之间呈负相关（r=-.80、r=-.86和r=-.83）。随访时，MPR与最小狭窄直径之间（MPR1：斜率，0.52对0.91；MPR2：斜率，1.48对1.95）以及MaxFR与净管腔增益之间（斜率，
