Use of an emboli containment and retrieval system during percutaneous coronary angioplasty in native coronary arteries.
Use of an emboli containment and retrieval system during percutaneous coronary angioplasty in native coronary arteries.
复制标题
在天然冠状动脉的经皮冠状动脉血管成形术中使用栓塞遏制和回收系统。
作者：
Gabor Sütsch;Wolfgang Kiowski;A. Bossard;Thomas F. Lüscher;W. Maier;Pierre Vogt;Franz W. Amann
背景
为了减少介入治疗后的发病率和死亡率，在经皮冠状动脉血运重建术中预防远端栓塞术可能是必要的。
方法和结果
我们在经皮冠状动脉成形术和支架置入术中使用了一种新开发的天然冠状动脉栓子遏制和回收系统，选择了39例患者(平均年龄58.9±10.1岁，女性11例)，表现为急性(n=22；8个LAD，3个LAD，11个RCA)、亚急性(n=7；2个LAD，2个LAD，3个RCA)或慢性(n=6；2个LAD，4个RCA)梗塞相关血管完全或次全闭塞，或伴有严重狭窄和不稳定心绞痛症状(n=4；2个LAD，2个RCA)。所有患者血管造影结果良好，术后血流正常，支架置入保护装置辅助血管成形术顺利进行。36例清醒患者中19例(急性7例，亚急性7例，慢性闭塞3例，不稳定型心绞痛2例)在闭塞气囊扩张过程中心绞痛间歇性加重(从2.5分钟至最长25分钟)，但未引起远端闭塞中断或血流动力学不稳定。在31名患者中，抽吸物中含有可见的碎片。组织学分析显示，颗粒大小可达12毫米，由坏死核、炎细胞、胆固醇碎片以及陈旧和新鲜血栓组成。在8名患者中，吸入的颗粒太小，无法进行显微镜诊断或没有碎片。
结论
这份初步报告证明了在天然冠状动脉中使用保护装置以防止在经皮介入治疗过程中动员的颗粒物远端栓塞的可行性。在某种程度上，这种材料有助于远端栓塞术、无再流和脑梗塞的机制，这种装置可能有助于减少此类并发症。需要适当设计的试验来评估该系统的临床益处。
BACKGROUND
Prevention of distal embolisation during percutaneous coronary revascularisation may be necessary to reduce postinterventional morbidity and mortality.
METHODS AND RESULTS
We employed a newly developed emboli containment and retrieval system in native coronary arteries during percutaneous coronary angioplasty and stenting in 39 selected patients (mean age 58.9 +/- 10.1 years, 11 females) presenting with acute (n = 22; 8 LAD, 3 LCX, 11 RCA), subacute (n = 7; 2 LAD, 2 LCX, 3 RCA) or chronic (n = 6; 2 LAD, 4 RCA) total or subtotal occlusion of an infarct-related vessel, or with severe stenosis and symptoms of unstable angina (n = 4; 2 LAD, 2 RCA). Protection device-assisted angioplasty with stent implantation was uneventful in all patients with good angiographic results and normal postprocedural flow. Intermittent aggravation of anginal pain during inflation of the occlusive balloon (from 2.5 to a maximum of 25 minutes cumulative inflation time) was observed in 19 of the 36 conscious patients (7 with acute, 7 with subacute and 3 with chronic occlusion, and 2 with unstable angina), but caused neither interruption of distal occlusion nor haemodynamic instability. In 31 patients the aspirates contained visible debris. Histological analysis showed particles up to 12 mm in size, consisting of necrotic core, inflammatory cells, cholesterol debris, and old and fresh thrombi. In 8 patients the aspirated particles were too small to allow microscopic diagnosis or debris was absent.
CONCLUSIONS
This preliminary report demonstrates the feasibility of using a protection device in native coronary arteries to prevent distal embolisation of particulate matter that is mobilised during percutaneous interventions. To the extent that this material contributes to the mechanisms of distal embolisation, noreflow and infarction, this device may help to reduce such complications. Appropriately designed trials are required to assess the clinical benefit of this system.