Seyithanoglu B Y, Zaki Masud A R, Ergene O, Morris W M, Kozan O, Corbelli J C, Wilson M F
Dokuz Eylül University Medical Faculty Hospital, Izmir, Turkey.
Jpn Heart J. 1998 Jan;39(1):55-65. doi: 10.1536/ihj.39.55.
It has been proposed that directional coronary atherectomy (DCA) should be an intervention of choice in larger vessels as one can achieve a greater minimal luminal diameter with DCA than with percutaneous transluminal coronary angioplasty (PTCA). This in turn should translate into a higher success rate and may even reduce the restenosis rate. The aim of this study was to compare DCA versus PTCA in vessels > 3 mm in diameter. One hundred fifty consecutive patients who met the inclusion criteria and had DCA were compared to 150 similarly selected PTCA patients. PTCA patients were selected from the era immediately preceding the advent of DCA so that selections bias could be excluded. All patients with ostial lesions, restenosis, vessels < 3 mm in diameter, and vessels with more than two significant lesions were excluded. Distal segments and circumflex cases were excluded as they formed a small subsegment. Both groups were similar in terms of demographic, clinical and angiographic variables. Quantitative analysis showed that the initial net gain was significantly greater in the DCA group than in the PTCA group (2.36 +/- 0.8 mm vs. 1.78 +/- 0.7 mm; p < 0.05). Residual stenosis was 11% with DCA compared to 33% with PTCA (p < 0.05). Despite these improved anatomical results the procedural success rates were similar (91.5% vs 84%). Major in hospital complications (death, acute occlusion, MI, emergency CABG, re-do) were higher in the DCA group than in the PTCA group (12% vs 6%). Clinical follow-up on 276 patients (150 DCA vs 126 PTCA) showed a 6 month clinical restenosis rate of 18% vs 28%, respectively. The incidence of re-do in 24 hours for acute occlusion was 6% for DCA and 1% for PTCA. In large-sized vessels DCA results in a lower restenosis rate. However, despite a lower incidence of residual stenosis, the complication rate tends to be higher with DCA (p < 0.05).
有人提出，定向冠状动脉斑块旋切术（DCA）应作为较大血管介入治疗的首选，因为与经皮腔内冠状动脉成形术（PTCA）相比，DCA能获得更大的最小管腔直径。这反过来应能转化为更高的成功率，甚至可能降低再狭窄率。本研究的目的是比较直径大于3mm血管的DCA与PTCA。将150例符合纳入标准并接受DCA的连续患者与150例同样入选的PTCA患者进行比较。PTCA患者选自DCA出现之前的时期，以便排除选择偏倚。所有开口病变、再狭窄、直径小于3mm的血管以及有两个以上明显病变的血管患者均被排除。远端节段和回旋支病例因构成较小亚组而被排除。两组在人口统计学、临床和血管造影变量方面相似。定量分析显示，DCA组的初始净增管腔直径显著大于PTCA组（2.36±0.8mm对1.78±0.7mm；p<0.05）。DCA组的残余狭窄率为11%，而PTCA组为33%（p<0.05）。尽管这些解剖学结果有所改善，但手术成功率相似（91.5%对84%）。DCA组的主要院内并发症（死亡、急性闭塞、心肌梗死、急诊冠状动脉搭桥术、再次手术）高于PTCA组（12%对6%）。对276例患者（150例DCA对126例PTCA）的临床随访显示，6个月的临床再狭窄率分别为18%和28%。DCA组急性闭塞24小时内再次手术的发生率为6%，PTCA组为1%。在大血管中，DCA导致较低的再狭窄率。然而，尽管残余狭窄发生率较低，但DCA的并发症发生率往往较高（p<0.05）。
