在传统球囊血管成形术获得最佳（类似支架）初始血管造影结果后发生的冠状动脉再狭窄。

Coronary restenosis after optimal (stent-like) initial angiographic results obtained by traditional balloon angioplasty.

作者信息

Di Luzio V, De Remigis F, De Curtis G, Paparoni S, Pecce P, Di Emidio L, Prosperi F, D'Aroma A, Balducelli M, Maresta A

机构信息

Dipartimento di Cardiologia e Cardiochirurgia, Ospedale Civile, Teramo.

出版信息

G Ital Cardiol. 1997 Jul;27(7):645-53.

PMID:9282284

Abstract

BACKGROUND AND OBJECTIVE

Elective native coronary artery stenting has shown its efficacy in lowering restenosis rates (RR) usually occurring after balloon angioplasty (PTCA). However ability of conventional PTCA to consistently provide low RR, through the achievement of large acute stent-like angiographic results, has not been investigated. This study was conducted to: (1) assess ability of optimal initial dilatation (OID), defined by residual lumen narrowing < or = 20%, significantly reduce current high RR following traditional PTCA; (2) evaluate the efficacy of OID obtainable by conventional PTCA in influencing adverse effects of single variables predisposing to restenosis.

METHODS

Of consecutive 601 patients who underwent PTCA, 569 (94.6%), 483 men and 86 women, aged 38-76 years, had a successful procedure on 645/678 lesions (95.1%). After a plaque fracture was obtained by the first inflation, step-increases in pressure of 1 atm and 60 second-inflation-times were applied, until a large lumen (the nearest to normal) and smooth contours were seen, or any wall damage detected by using step-by-step angiographic tests. Acute optimal results (group A) were 450 (69.7%) and sub-optimal results (group B) were 203 (30.3%). After a mean time of 9 +/- 1.8 months, 543 patients (95.4%) had angiographic restudy on 611 (94.7%) successfully treated lesions.

RESULTS

Restenosis (> 50% stenosis at restudy) occurred in 27.1% of patients and in 24.5% of lesions. RR was 18.8% in group A and 37.8% in group B (p < 0.0001). Significant lower RR were observed in group A in comparison with group B, for single variables examined, except for length > 10 mm. By multivariate analysis of all treated lesions, sub-optimal initial dilatation, unstable angina, lesion length > 10 mm and eccentricity emerged as major determinants of restenosis. Following OID only length > 10 mm was highly predictive of this event and, in the absence of this adverse variable, RR was only 13.6%.

CONCLUSION

Counterbalancing adverse effects of many variables predisposing to restenosis, OID obtained by traditional PTCA seem to significantly reduce the risk of recurrence, particularly in lesions no longer than 10 mm.

摘要

背景与目的

选择性自体冠状动脉支架置入术已显示出其在降低通常发生于球囊血管成形术（PTCA）后的再狭窄率（RR）方面的疗效。然而，传统PTCA通过实现类似支架置入后的大急性血管造影结果来持续提供低RR的能力尚未得到研究。本研究旨在：（1）评估以残余管腔狭窄≤20%定义的最佳初始扩张（OID）显著降低传统PTCA后当前高RR的能力；（2）评估传统PTCA可获得的OID在影响易导致再狭窄的单一变量的不良反应方面的疗效。

方法

在连续601例行PTCA的患者中，569例（94.6%），男性483例，女性86例，年龄38 - 76岁，645/678处病变（95.1%）手术成功。在首次球囊扩张获得斑块破裂后，每次压力递增1个大气压，球囊扩张时间为60秒，直至观察到较大管腔（最接近正常）和光滑轮廓，或通过逐步血管造影检查检测到任何血管壁损伤。急性最佳结果（A组）为450例（69.7%），次优结果（B组）为203例（30.3%）。平均9±1.8个月后，543例患者（95.4%）对611处（94.7%）成功治疗的病变进行了血管造影复查。

结果

再狭窄（复查时狭窄>50%）发生在27.1%的患者和24.5%的病变中。A组的RR为18.8%，B组为37.8%（p<0.0001）。除病变长度>10 mm外，在所有检查的单一变量中，A组的RR显著低于B组。对所有治疗病变进行多因素分析显示，次优初始扩张、不稳定型心绞痛、病变长度>10 mm和偏心性是再狭窄的主要决定因素。在进行OID后，只有病变长度>10 mm高度预测这一事件，并且在没有这个不良变量的情况下，RR仅为13.6%。