Asakaura Y, Takagi S, Ishikawa S, Asakura K, Sueyoshi K, Sakamoto M, Takatsuki S, Oda T, Nakagawa M, Furukawa Y, Oyamada K, Iwanaga S, Ogawa S, Hinohara T
Cardiopulmonary Division, Keio University, Tokyo, Japan.
Cathet Cardiovasc Diagn. 1998 Jan;43(1):95-100. doi: 10.1002/(sici)1097-0304(199801)43:1<95::aid-ccd28>3.0.co;2-r.
We examined the effectiveness of Palmaz-Schatz (P-S) stent and directional coronary atherectomy (DCA) in ostial lesions of left anterior descending arteries (LAD). The P-S stent was implanted in 11 cases at LAD ostial lesions, and DCA was performed in 13 cases. Percent stenosis and vessel diameter at the target site and the ostium of the circumflex coronary artery (LCX) were measured before and after the procedure. The initial success rate was 100% in both groups. No major complication occurred. LAD ostial lesions were improved from 81.3+/-3.4% to -8.1+/-5.7% by P-S stent and from 82.8+/-2.6% to -2.7+/-3.9% by DCA. LCX ostial vessel diameter was not changed by DCA (from 3.0+/-0.2 mm to 3.1+/-0.3 mm); however, it was significantly decreased by P-S stent (from 2.9+/-0.2 mm to 2.6+/-0.2 mm, P < 0.01). When the angle of LAD and LCX was < or = 80 degrees from the view of RAO 30 degrees and Caudal 30 degrees, the LCX ostium was significantly narrowed by stenting at LAD ostium (P < 0.01). These findings indicate that both the P-S stent and DCA are effective and safe therapies for LAD ostial lesions in cases with LAD-LCX angle > 80 degrees. In cases with LAD-LCX angle < or = 80 degrees, however, DCA is a favored therapy rather than P-S stenting to avoid narrowing of the LCX ostium.
我们研究了帕尔马兹-沙茨（P-S）支架和冠状动脉定向旋切术（DCA）在左前降支（LAD）开口病变中的有效性。11例LAD开口病变患者植入了P-S支架，13例患者接受了DCA治疗。在手术前后测量了靶病变部位以及回旋支冠状动脉（LCX）开口处的狭窄百分比和血管直径。两组的初始成功率均为100%。未发生重大并发症。P-S支架使LAD开口病变从81.3±3.4%改善至-8.1±5.7%，DCA使其从82.8±2.6%改善至-2.7±3.9%。DCA未改变LCX开口处血管直径（从3.0±0.2mm至3.1±0.3mm）；然而，P-S支架使其显著减小（从2.9±0.2mm至2.6±0.2mm，P<0.01）。从右前斜30度和尾位30度视角看，当LAD与LCX的夹角≤80度时，在LAD开口处植入支架会使LCX开口明显变窄（P<0.01）。这些发现表明，对于LAD-LCX夹角>80度的病例，P-S支架和DCA都是治疗LAD开口病变有效且安全的方法。然而，对于LAD-LCX夹角≤80度的病例，DCA是更可取的治疗方法，而非P-S支架植入，以避免LCX开口变窄。
