Sankardas M A, McEniery P, Aroney C, Holt G, Cameron J, Garrahy P, Dare A, Bett N
Department of Cardiology, Prince Charles Hospital, Brisbane, Qld.
Aust N Z J Med. 1995 Dec;25(6):676-80. doi: 10.1111/j.1445-5994.1995.tb02852.x.
Directional coronary atherectomy is a percutaneous technique which extends the role of balloon angioplasty to bulky eccentric coronary lesions.
To report the early experience, clinical results, complications and histopathological findings of directional coronary atherectomy (DCA) in proximal left anterior descending artery (LAD) stenosis.
Study of 25 lesions in 24 patients on whom directional atherectomy was performed on the proximal LAD artery with the Simpson coronary atherectomy device.
Twenty-five procedures were performed on 24 patients with stenosis in the proximal LAD artery. There were 21 males and three females with a mean age of 56.5 years. Sixteen patients presented with stable angina and eight with unstable angina. Eight patients had previous myocardial infarction (MI). Angiographic success was obtained in 24 of 25 lesions (96%). The mean lesion length was 13.1 +/- 3.7 mm and the mean LAD artery diameter was 3.6 +/- 0.5 mm. Minimal luminal diameter improved from 0.9 +/- 0.4 mm to 3.0 +/- 0.5 mm and the percentage diameter stenosis reduced from 75 +/- 12% to 16 +/- 9%. Complications included acute occlusion in one patient, non-Q MI in three patients, local vascular complications in one patient and side-branch loss in one patient. Histology demonstrated fibrous cap of atherosclerotic plaque in 100%, media and internal elastic lamina in 28% and intimal hyperplasia in 100% of restenotic lesions and 27% of native lesions. Restenosis rates in angiographically restudied patients was 27%. The mean minimal luminal diameter at follow-up was 2.3 +/- 0.9 mm and the mean percentage diameter stenosis was 35 +/- 21%.
From this initial study, we conclude that DCA is an effective and safe procedure for the treatment of large proximal LAD lesions. DCA provides a large luminal diameter and "smoother' angiographic appearance compared to coronary angioplasty. Acute complication rates are low and restenosis rates were comparable with percutaneous transluminal coronary balloon angioplasty.
定向冠状动脉斑块旋切术是一种经皮技术，它将球囊血管成形术的作用扩展至治疗体积较大的偏心冠状动脉病变。
报告定向冠状动脉斑块旋切术（DCA）治疗左前降支（LAD）近端狭窄的早期经验、临床结果、并发症及组织病理学发现。
对24例患者的25处病变进行研究，使用Simpson冠状动脉斑块旋切装置对LAD近端动脉进行定向斑块旋切术。
对24例LAD近端动脉狭窄患者进行了25次手术。其中男性21例，女性3例，平均年龄56.5岁。16例患者表现为稳定型心绞痛，8例为不稳定型心绞痛。8例患者既往有心肌梗死（MI）。25处病变中有24处（96%）获得血管造影成功。平均病变长度为13.1±3.7mm，平均LAD动脉直径为3.6±0.5mm。最小管腔直径从0.9±0.4mm改善至3.0±0.5mm，直径狭窄百分比从75±12%降至16±9%。并发症包括1例急性闭塞、3例非Q波心肌梗死、1例局部血管并发症和1例分支血管丢失。组织学显示，再狭窄病变的100%有动脉粥样硬化斑块的纤维帽，28%有中膜和内弹力层，100%有内膜增生，原生病变的27%有内膜增生。血管造影复查患者的再狭窄率为27%。随访时平均最小管腔直径为2.3±0.9mm，平均直径狭窄百分比为35±21%。
从这项初步研究中，我们得出结论，DCA是治疗LAD近端大型病变的一种有效且安全的方法。与冠状动脉血管成形术相比，DCA可提供更大的管腔直径和“更平滑”的血管造影表现。急性并发症发生率低，再狭窄率与经皮腔内冠状动脉球囊血管成形术相当。
