Villavicencio R, Arceo A, Meléndez H, Ariza H, Martínez Ríos M A
Instituto Nacional de Cardiología "Ignacio Chávez", Departamento de Hemodinámica, Tlalpan, México, D.F.
Arch Inst Cardiol Mex. 1996 Sep-Oct;66(5):406-14.
Directional coronary atherectomy (DCA) is a percutaneous revascularization procedure. The basic indications are complex lesions (excentricity, irregular borders with ulceration and in non-calcified lesions in large coronary vessels or in vein grafts). DCA in recent years has been a useful procedure in several circumstances, in which initial results with conventional coronary angioplasty had failed, specifically in those conditions like acute occlusions, threatened closure or "elastic recoil" phenomenal, focal dissection or residual stenosis > 50% due to hare atherosclerotic plaque. In this report two cases of "rescue" DCA due to residual stenosis > 50% because of "elastic recoil" are presented. One of them had a concentric lesion and the other a marked excentricity. Both cases had primary success. Atheroma was shown by histopathology. Rescue DCA is a useful feasible alternative procedure in selected cases, in which conventional coronary angioplasty had initially not been successful.
定向冠状动脉斑块旋切术（DCA）是一种经皮血管重建手术。其基本适应证为复杂病变（偏心性、边界不规则伴溃疡，以及大冠状动脉血管或静脉移植物中的非钙化病变）。近年来，DCA在多种情况下都是一种有用的手术，在这些情况下，传统冠状动脉成形术的初始结果失败，特别是在急性闭塞、有闭塞风险或“弹性回缩”现象、局灶性夹层或由于硬斑块导致残余狭窄>50%等情况。在本报告中，介绍了两例因“弹性回缩”导致残余狭窄>50%而进行“挽救性”DCA的病例。其中一例为同心性病变，另一例为明显偏心性病变。两例均取得了初步成功。组织病理学显示有动脉粥样硬化斑块。挽救性DCA在某些传统冠状动脉成形术最初未成功的选定病例中是一种有用且可行的替代手术。
