Weinberger J, Simon A D
Interventional Cardiology Center, Columbia-Presbyterian Medical Center, New York, NY 10032, USA.
Curr Opin Cardiol. 1997 Sep;12(5):468-74.
Restenosis after coronary angioplasty is a major limitation of an otherwise highly effective and safe procedure for the treatment of atherosclerotic coronary artery disease. Although the advent of coronary stenting has reduced restenosis rates for selected patients, an overall restenosis rate of 20% to 25% remains. Despite numerous trials, no effective pharmacologic therapy has been found. Intracoronary irradiation is a new technique proposed to prevent restenosis after angioplasty. In animal models of restenosis after balloon injury, there is marked reduction of neointimal proliferation when the injured vessel is irradiated, using a variety of radiation sources and delivery systems. Early human trials have underscored the importance of careful source calibration and dosimetry. A small, randomized, double-blind, placebo-controlled study of intracoronary irradiation to prevent recurrent restenosis recently reported striking reductions in angiographic restenosis as well as clinical event rates. A number of important issues remain unresolved, such as defining which component of the arterial wall serves as the target tissue for radiation, the minimal effective dose, the maximum tolerable dose, and user-friendly radiation delivery systems. Further studies are needed to define the safety, efficacy and the ultimate usefulness of intracoronary irradiation as an adjunct to current procedures in interventional cardiology.
冠状动脉血管成形术后再狭窄是治疗动脉粥样硬化性冠状动脉疾病这一原本高效且安全的手术的主要限制因素。尽管冠状动脉支架置入术的出现降低了部分患者的再狭窄率，但总体再狭窄率仍维持在20%至25%。尽管进行了大量试验，仍未找到有效的药物治疗方法。冠状动脉内照射是一种为预防血管成形术后再狭窄而提出的新技术。在球囊损伤后再狭窄的动物模型中，使用各种辐射源和输送系统对受损血管进行照射时，内膜增生会显著减少。早期人体试验强调了仔细进行源校准和剂量测定的重要性。最近一项关于冠状动脉内照射预防复发性再狭窄的小型随机双盲安慰剂对照研究报告称，血管造影再狭窄以及临床事件发生率显著降低。许多重要问题仍未解决，例如确定动脉壁的哪个组成部分作为辐射的靶组织、最小有效剂量、最大耐受剂量以及用户友好的辐射输送系统。需要进一步研究来确定冠状动脉内照射作为介入心脏病学当前手术辅助手段的安全性、有效性和最终实用性。
