Nishijima H, Meno H, Higashi H, Yamada K, Hamanaka N, Takeshita A
Division of Internal Medicine, Hamanomachi General Hospital, Fukuoka, Japan.
Jpn Circ J. 1996 Oct;60(10):789-96. doi: 10.1253/jcj.60.789.
To elucidate the changes in coronary vasomotion in a previously balloon-dilated segment, we examined the vasoconstricting response of previously balloon-dilated and non-dilated segments to acetylcholine. Acetylcholine was administered into coronary arteries cumulatively (left and right coronary artery: 10-100 micrograms) in 15 patients (age: 60 +/- 3 years, 12 males and 3 females) at 7.4 +/- 1.5 months after successful percutaneous transluminal coronary angioplasty (PTCA). In PTCA segments with no restenosis, does-dependent constriction in response to acetylcholine was observed in only 1 patient. In non-PTCA segments of PTCA and non-PTCA arteries, 12 patients showed dose-dependent vasoconstriction in response to acetylcholine. Coronary spasm, which was defined as a more than 75% reduction in coronary diameter compared with that after isosorbide dinitrate, was provoked in one PTCA segment (7%). In non-PTCA segments of PTCA and non-PTCA arteries, 15 of 44 arteries (34%) demonstrated coronary spasm in 9 of 15 patients (60%, p < 0.005 vs PTCA segment). In conclusion, PTCA segments free of restenosis showed no hyper-reactivity to acetylcholine, while non-PTCA segments showed hypercontractility in response to acetylcholine. Coronary balloon angioplasty may alter the coronary vasomotor reaction to acetylcholine several months after angioplasty.
为了阐明先前球囊扩张节段冠状动脉血管运动的变化，我们检测了先前球囊扩张节段和未扩张节段对乙酰胆碱的血管收缩反应。在成功进行经皮腔内冠状动脉成形术（PTCA）后7.4±1.5个月，对15例患者（年龄：60±3岁，男12例，女3例）的冠状动脉（左冠状动脉和右冠状动脉）累积给予乙酰胆碱（10 - 100微克）。在无再狭窄的PTCA节段中，仅1例患者观察到对乙酰胆碱的剂量依赖性收缩。在PTCA动脉和非PTCA动脉的非PTCA节段中，12例患者表现出对乙酰胆碱的剂量依赖性血管收缩。在一个PTCA节段（7%）诱发了冠状动脉痉挛，冠状动脉痉挛定义为与硝酸异山梨酯给药后相比冠状动脉直径减少超过75%。在PTCA动脉和非PTCA动脉的非PTCA节段中，44条动脉中的15条（34%）在15例患者中的9例（60%）出现冠状动脉痉挛（与PTCA节段相比，p < 0.005）。总之，无再狭窄的PTCA节段对乙酰胆碱无高反应性，而非PTCA节段对乙酰胆碱表现出高收缩性。冠状动脉球囊成形术可能在血管成形术后数月改变冠状动脉对乙酰胆碱的血管运动反应。
