Vallbracht C, Unverdorben M, Kadel C, Oster H, Otto J, Kober G, Kaltenbach M
Center for Cardiovascular Diseases, Rotenburg a.d.Fulda, Germany.
J R Soc Med. 1997 Apr;90(4):209-11. doi: 10.1177/014107689709000407.
In chronic coronary occlusions the chance of successful reopening by angioplasty can be judged from the age of the occlusion. Often, however, time since occlusion cannot be accurately assessed. Therefore we determined whether the chance of reopening can be predicted from angiographic morphology. In cineangiograms from 60 consecutive patients with chronic coronary occlusions morphological details in at least two projections were evaluated in relation to the rate of success and the estimated age of occlusion. Morphological features associated with a higher rate of success (type A) were a clearcut proximal stump, absence of side branches at the site of occlusion, absence of bridging collaterals, and only slight filling of the distal part of the vessel. Features associated with a low success rate (type B) were absence of proximal stump, side branches at the site of occlusion, bridging collaterals, and rapid high-contrast filling of the distal part of the vessel. 48/60 (80%) of occlusions could be classified as type A or type B. The success rate was 17/21 (81%) in type A versus 5/27 (18.5%) in type B (P < 0.0002). The estimated age of type B occlusions was higher than that of type A medians 8 and 4 months (P < 0.002). Thus in chronic coronary occlusions the likelihood of successful reopening can be judged in many patients from morphological features.
在慢性冠状动脉闭塞病变中，通过血管成形术成功再通的可能性可根据闭塞时间来判断。然而，闭塞时间往往无法准确评估。因此，我们确定能否根据血管造影形态来预测再通的可能性。在连续60例慢性冠状动脉闭塞患者的电影血管造影片中，至少在两个投照位上评估了与成功率和估计闭塞时间相关的形态学细节。与较高成功率（A型）相关的形态学特征包括近端残端清晰、闭塞部位无侧支、无桥接侧支以及血管远端仅有轻微充盈。与低成功率（B型）相关的特征包括无近端残端、闭塞部位有侧支、桥接侧支以及血管远端快速的高对比度充盈。60例闭塞病变中有48例（80%）可归为A型或B型。A型的成功率为17/21（81%），而B型为5/27（18.5%）（P<0.0002）。B型闭塞的估计时间高于A型，中位数分别为8个月和4个月（P<0.002）。因此，在慢性冠状动脉闭塞病变中，许多患者可根据形态学特征判断成功再通的可能性。
