DETERMINANTS OF COLLATERAL FILLING OBSERVED DURING SUDDEN CONTROLLED CORONARY-ARTERY OCCLUSION IN HUMAN-SUBJECTS
DETERMINANTS OF COLLATERAL FILLING OBSERVED DURING SUDDEN CONTROLLED CORONARY-ARTERY OCCLUSION IN HUMAN-SUBJECTS
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DOI：
10.1016/0735-1097(89)90502-0
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发表时间：
1989-02-01
影响因子：
24
通讯作者：
GORLIN, R
中科院分区：
文献类型：
--
作者：
COHEN, M;SHERMAN, W;GORLIN, R
在接受冠状动脉成形术的单支冠状动脉疾病患者中，较高级别的侧支循环限制了球囊扩张时观察到的心肌缺血的程度。然而，冠状动脉突然闭塞时侧支循环的充盈程度因患者而异。为了评估哪些特征可以预测高级别的侧支循环充盈，对67例接受左前降支或右冠状动脉成形术的患者(心绞痛持续时间从1周到36个月)，对基线临床和血管造影变量与冠状动脉闭塞期间的充盈级别进行了相关性研究。另一个对侧动脉导管被用来评估血管成形术球囊短暂完全闭塞前和闭塞期间到达扩张血管的侧支充盈情况。36例患者近端狭窄病变的严重程度从65%到99%不等。在0.001至3分中，平均抵押品填充等级在通胀前为0.4%，而在通胀期间为1.8%(p=1.8%)。狭窄程度在95%~99%的19例患者在扩张期间至少有2级侧支循环充盈。相比之下，18至21名患有.80%的狭窄在充盈时仅有0级或1级侧支循环充盈。充盈时侧支循环分级与1)基线病变严重程度(r=0.76)、2、侧支循环充盈分级(r=0.50)、3)血管扩张呈显著正相关。充盈期间侧支循环充盈与年龄、性别、危险因素、心绞痛持续时间或病变近端和远端位置无关。病变严重程度是唯一与侧支循环充盈分级相关的自变量。在血管成形术前可用的基线变量中，病变狭窄是侧支循环储备的最佳预测因子。心肌梗死前存在的狭窄百分比和相关的侧支储备可能解释了急性冠状动脉血栓形成后观察到的心肌梗死面积的某些差异。
Higher grades of collateral circulation limit the extent of myocardial ischemia observed during balloon inflation in patients with single vessel coronary disease undergoing coronary disease undergoing coronary angioplasty. However, the grade of collateral filling during sudden coronary occlusion varies from patient to patient. To assess which characteristics may predict a high grade of collateral filling, baseline clinical and angiographic variables were correlated with the grade of filling during coronary occlusion in 67 patients (whose angina ranged from 1 week to 36 months in duration) undergoing left anterior descending or right coronary artery angioplasty. A second contralateral arterial catheter was used to assess the collateral filling that reached the vessel dilated before and during transient total occlussion by the angioplasty balloon. Thirty-six patients had a proximal stenotic lesion ranging in severity from 65 to 99%. On a 0 to 3 scale, mean collateral filling grade before inflation was 0.4 versus 1.8 during inflation (p=0.001). All 19 patients wth 95 to 99% stenosis had at least grade 2 collateral filling during inflation. In contrast, 18 to 21 patients with .ltoreq. 80% stenosis had only grade 0 or 1 collateral filling during inflation. There were significant positive correlations between collateral grade during inflation and 1) baseline lesion severity (r=0.76, 2) baseline collateral filling grade (r=0.50), and 3) vessel dilated. There was no relation between collateral filling during inflation and age, gender, risk factors, duration of angina or proximal versus distal location of the lesion. Lesion severity was the only independent variable associated with collateral filling grade. Among the baseline variables available before angioplasty, lesion stenosis is the best predictor of collateral flow reserve. The percent stenosis present before myocardial infarction and the associated collateral reserve may explain some of the variability in infarct size observed after acute coronary artery thrombosis.