Rambaldi R, Hamburger J N, Geleijnse M L, Poldermans D, Kimman G J, Aiazian A A, Fioretti P M, Ten Cate F J, Roelandt J R, Serruys P W
Thoraxcenter, University Hospital Rotterdam-Dijkzigt, and Erasmus University, Rotterdam, The Netherlands.
Am Heart J. 1998 Nov;136(5):831-6. doi: 10.1016/s0002-8703(98)70128-0.
Patients with symptomatic myocardial ischemia from a chronic totally occluded coronary (TOC) artery are usually referred for coronary artery bypass surgery. Because guide wire technology has improved considerably in recent years, percutaneous coronary angioplasty has become a useful technique in opening chronic TOC arteries. We evaluated the early functional results of successful percutaneous recanalization by performing dobutamine stress echocardiography (DSE).
Fifteen patients with a chronic TOC artery who underwent a successful recanalization were prospectively studied. Each patient had a DSE within 24 hours before and 48 hours after the procedure. Wall motion was scored according to a 16-segment/5-point model. A clinical and angiographic follow-up of 6 months was obtained.
The wall motion score index at rest improved from 1.26+/-0.23 before to 1.22+/-0.21 after the procedure (P < .05). Of those 10 segments that improved at rest, 7 were collateral recipients and 3 were collateral donors. The number of ischemic segments decreased from 46 before to 4 after the procedure (P < .0001). Wall motion score index at peak stress improved from 1.34+/-0.20 before to 1.15+/-0.12 after the procedure (P < .05). DSE was positive for ischemia in 15 patients before and 2 patients after the procedure (P < .0001). Angina was present in 12 patients before and in 2 patients after recanalization (P < .0001). Two patients (13%) had angiographic reocclusion and 5(33%) restenosis after 6 months of follow-up.
Successful percutaneous recanalization of chronic TOC artery results in an early improvement of both clinical status and resting or stress-induced wall motion abnormalities, as detected by DSE.
患有慢性完全闭塞冠状动脉（TOC）且有症状性心肌缺血的患者通常会被转诊进行冠状动脉搭桥手术。由于近年来导丝技术有了显著改进，经皮冠状动脉成形术已成为开通慢性TOC动脉的一项有用技术。我们通过进行多巴酚丁胺负荷超声心动图（DSE）评估了成功经皮再通的早期功能结果。
对15例成功进行再通的慢性TOC动脉患者进行前瞻性研究。每位患者在手术前24小时内及手术后48小时内进行DSE检查。根据16节段/5分模型对室壁运动进行评分。获得了6个月的临床和血管造影随访结果。
静息时室壁运动评分指数从术前的1.26±0.23改善至术后的1.22±0.21（P <.05）。在静息时改善的10个节段中，7个是侧支接受者，3个是侧支供血者。缺血节段数量从术前的46个减少至术后的4个（P <.0001）。负荷高峰时室壁运动评分指数从术前的1.34±0.20改善至术后的1.15±0.12（P <.05）。术前15例患者DSE显示缺血阳性，术后2例患者显示缺血阳性（P <.0001）。再通术前12例患者有胸痛症状，术后2例患者有胸痛症状（P <.0001）。随访6个月后，2例患者（13%）出现血管造影再闭塞，5例患者（33%）出现再狭窄。
慢性TOC动脉成功的经皮再通可使临床状况以及静息或负荷诱发的室壁运动异常早期得到改善，这可通过DSE检测到。
