Long-term luminal renarrowing after successful elective coronary angioplasty of total occlusions. A quantitative angiographic analysis.
Long-term luminal renarrowing after successful elective coronary angioplasty of total occlusions. A quantitative angiographic analysis.
复制标题
成功选择性完全闭塞冠状动脉血管成形术后的长期管腔再狭窄。
DOI：
10.1161/01.cir.91.8.2140
复制
发表时间：
1995
期刊：
影响因子：
37.8
通讯作者：
P. Serruys
中科院分区：
文献类型：
--
作者：
A. Violaris;R. Melkert;P. Serruys
背景
冠状动脉闭塞成功扩张后的长期血管造影结果仍不清楚。本研究的目的是通过定量血管造影检查在预定时间间隔成功球囊扩张冠状动脉闭塞后的长期再狭窄，并将其与狭窄对照人群进行比较。
方法和结果
研究人群包括2950例患者（3583处病变），前瞻性入组并成功完成了4项主要再狭窄试验（86%的定量血管造影随访）。在中心实验室使用自动内插边缘检测技术处理和分析血管造影电影。研究人群包括266处闭塞（7%），定义为总闭塞（109处病变）和功能性闭塞（157处病变），其中总闭塞定义为病变外无顺行充盈，功能性闭塞定义为远端节段出现微弱的晚期顺行混浊，且无可辨别的管腔连续性; 3317处病变定义为狭窄（93%）。闭塞成功扩张后的再狭窄率明显高于狭窄。采用分类（随访时直径狭窄> 50%）方法，闭塞的再狭窄率为44.7%，狭窄的再狭窄率为34.0%（P <0.001;相对危险度，1.575; CI，1.224 - 2.027）。同样，绝对损失（定义为冠状动脉成形术后与随访之间最小管腔直径的变化;单位：毫米，平均值+/- SD）（0.43 +/- 0.68）闭塞组显著高于狭窄组（0.31 +/- 0.51，P <0.001），相对损失也是如此，相对损失定义为血管成形术后和随访之间最小管腔直径的变化，根据血管大小调整（0.17 +/- 0.28对比0.12 +/- 0.20，P <0.001）。闭塞组再狭窄率较高主要是由于该组随访血管造影时闭塞数量增加（19.2%，狭窄5.0%，P <0.001）。在闭塞组中，完全闭塞和功能性闭塞之间的长期结局没有显著差异（再狭窄率，45.0%对44.6%;再闭塞率，23.9%对15.9%;绝对损失，0.53 +/- 0.69对0.36 +/- 0.67;相对损失，0.21 +/- 0.28对比0.15 +/- 0.28; P = NS）。
结论
这些结果表明，成功扩张的冠状动脉闭塞，无论是完全的还是功能性的，在6个月时的血管造影再狭窄率高于狭窄。这主要是由于该组病变在随访血管造影时闭塞率较高。旨在减少冠状动脉闭塞成功扩张后再狭窄的措施应该集中在这个方向。
BACKGROUND
The long-term angiographic outcome after successful dilatation of coronary occlusions remains unclear. The objective of this study was to examine long-term restenosis after successful balloon dilatation of coronary occlusions at a predetermined time interval with quantitative angiography and compare this with a control population of stenoses.
METHODS AND RESULTS
The study population comprised 2950 patients (3583 lesions) prospectively enrolled in and successfully completing four major restenosis trials (86% quantitative angiographic follow-up). Cineangiographic films were processed and analyzed at a central core laboratory with the use of an automated interpolated edge detection technique. The study population comprised 266 occlusions (7%) defined as total when there was absent anterograde filling beyond the lesion (109 lesions) and functional (157 lesions) when faint, late anterograde opacification of the distal segment was seen in the absence of a discernible luminal continuity; 3317 lesions were defined as stenoses (93%). Restenosis was significantly higher after successful dilatation of occlusions than of stenoses. With the categorical (> 50% diameter stenosis at follow-up) approach, the restenosis rate was 44.7% in occlusions compared with 34.0% in stenoses (P < .001; relative risk, 1.575; CI, 1.224 to 2.027). Similarly, the absolute loss (defined as the change in minimal lumen diameter between post coronary angioplasty and follow-up; in millimeters, mean +/- SD) (0.43 +/- 0.68) in occlusions was significantly higher than in stenoses (0.31 +/- 0.51, P < .001), as was the relative loss, defined as the change in minimal lumen diameter between postangioplasty and follow-up, adjusted for the vessel size (0.17 +/- 0.28 versus 0.12 +/- 0.20, P < .001). The higher restenosis rate in the occlusions group was due predominantly to an increased number of occlusions at follow-up angiography in this group (19.2% compared with 5.0% for stenoses, P < .001). Within the occlusions group, there were no significant differences in long-term outcome between total and functional occlusions (restenosis rate, 45.0% versus 44.6%; reocclusion rate, 23.9% versus 15.9%; absolute loss, 0.53 +/- 0.69 versus 0.36 +/- 0.67; relative loss, 0.21 +/- 0.28 versus 0.15 +/- 0.28; P = NS).
CONCLUSIONS
These results indicate that successfully dilated coronary occlusions, both total and functional, have a higher rate of angiographic restenosis at 6 months than stenoses. This is due chiefly to a higher rate of occlusion at follow-up angiography in this group of lesions. Measures aimed at reducing restenosis after successful dilatation of coronary occlusion should be focused in this direction.
血小板和血栓形成在血管成形术后急性闭塞和再狭窄机制中的作用。
DOI：
10.1016/0002-9149(87)90479-6
发表时间：
1987
期刊：
The American journal of cardiology
影响因子：
--
作者：
Harker,LA
通讯作者：
Harker,LA