Altstidl R, Goth C, Lehmkuhl H, Bachmann K
Medizinische Klinik II mit Poliklinik, University of Erlangen-Nuremberg, Germany.
Angiology. 1997 Oct;48(10):863-70. doi: 10.1177/000331979704801003.
Quantitative coronary angiography was applied to investigate the degree and extent of coronary vasoconstriction following percutaneous transluminal coronary angioplasty (PTCA) in single-vessel disease of segments distal to the PTCA site (n = 46) and of control segments in nonmanipulated vessels (n = 33) before PTCA, 15 minutes after PTCA, and again 10 minutes after 10 mg sublingual isosonbide dinitrate (ISDN) in 46 patients receiving neither nitrates nor calcium channel blockers prior to PTCA. Furthermore, the degree of coronary vasoconstriction was compared with ergonovine-induced vasoconstriction (n = 8) as well as in patients with and without restenosis during follow-up angiography 4 months later. PTCA induced a moderate, but significant, vasoconstriction in both distal and control segments, with a reduction in coronary diameter from 2.34 +/- 0.58 to 2.26 +/- 0.55 mm (P = 0.011) and from 2.70 +/- 0.62 to 2.60 +/- 0.65 mm (P = 0.004), respectively. No correlation between the degree of vasoconstriction on the one side and lesion severity and PTCA-induced mechanical stretch, judged by the sum of the products of inflation pressure and time, on the other side was found. Vasoconstriction was within the limits achievable with the potent vasoconstrictor ergonovine and did not differ in patients with or without restenosis. ISDN led to a significant vasodilatation in all segments. In conclusion, coronary vasoconstriction following PTCA is present in the coronary tree in a rather diffuse way. It is not associated with stenosis severity or PTCA-induced mechanical stretch, suggesting a complex underlying mechanism. ISDN-reversible vasoconstriction was within the limits achievable with ergonovine and did not differ with regard to restenosis.
应用定量冠状动脉造影术，对46例在经皮腔内冠状动脉成形术（PTCA）前未使用硝酸盐类药物和钙通道阻滞剂的患者，研究PTCA部位远端单支血管病变（n = 46）以及未操作血管的对照节段（n = 33）在PTCA前、PTCA后15分钟、以及舌下含服10 mg硝酸异山梨酯（ISDN）10分钟后的冠状动脉收缩程度和范围。此外，将冠状动脉收缩程度与麦角新碱诱导的血管收缩（n = 8）进行比较，并在4个月后的随访血管造影中比较有或无再狭窄患者的情况。PTCA在远端节段和对照节段均引起中度但显著的血管收缩，冠状动脉直径分别从2.34±0.58 mm减小至2.26±0.55 mm（P = 0.011）和从2.70±0.62 mm减小至2.60±0.65 mm（P = 0.004）。未发现一侧的血管收缩程度与病变严重程度以及PTCA诱导的机械牵张（通过球囊充盈压力与时间乘积之和判断）之间存在相关性。血管收缩程度在强效血管收缩剂麦角新碱所能达到的范围内，有或无再狭窄的患者之间无差异。ISDN使所有节段均出现显著血管扩张。总之，PTCA后的冠状动脉收缩以较为弥漫的方式存在于冠状动脉树中。它与狭窄严重程度或PTCA诱导的机械牵张无关，提示存在复杂的潜在机制。ISDN可逆性血管收缩在麦角新碱所能达到的范围内，且在再狭窄方面无差异。
