MECHANISM ON THROMBOSIS AND RESTENOSIS AFTER LASER ANGIOPLASTY

在8只狗上比较了激光血管成形术与球囊血管成形术的致血栓性和增殖作用。血栓引起的平均狭窄面积百分比为62（±）SY。[）28球囊扩张，31（]SY.+-激光热疗+球囊扩张组29例，5例（±）SY.激光热处理6例，激光热处理1例60分钟时，直接激光节段中有2个（P<0.0005 vs球囊）。在8支动脉粥样硬化兔髂动脉中，激光热凝后平均管腔直径从0.19 mm增加到1.54 mm，球囊扩张后平均管腔直径从0.29 mm增加到1.84 mm（P<0.0001）。然而，由于血栓性再梗阻，在60分钟后，激光组和球囊组分别降至1.34和0.45（P<0.0001 vs术后即刻）。因此，激光热成形术比球囊成形术的血栓形成率低。一侧髂动脉粥样硬化性狭窄行球囊扩张，另一侧行激光血管成形术。血管造影后 ...更多信息 球囊扩张组管腔狭窄率从16%增加到58%（P<0.05），激光热扩张组管腔狭窄率从26%增加到30%，直接激光扩张组管腔狭窄率从28%增加到39%。结果表明，激光血管成形术可预防血管成形术后再狭窄。在治疗后1小时，激光热处理的血管镜检查平均血栓阻塞百分比为8.6%，对照球囊为41.9%（n=7，P<0.0001）。准分子组为3.8%，对照组为51.9%（n=8，P<0.001）.腔内阻塞率：准分子激光组1.4，钬YAG组2.6，Nd YAG组2.5，球囊组49（P<0.0001）。结果表明，脉冲激光治疗也能减少血栓形成，对18只犬的一侧髂动脉狭窄用球囊扩张，另一侧动脉用激光血管成形术扩张。10只犬在血管成形术前分别输注抗凝血酶或肝素。血管成形术后1小时，球囊对照组的平均血栓性狭窄为62%，激光热疗组为5%。肝素球囊组为8.6%，肝素激光组为1.2%，抗凝血酶激光组为0%。结果表明，激光治疗后的持续抗血栓治疗可完全预防血栓形成。我们对27例闭塞性动脉硬化症患者进行了激光热成形术，21例成功。抗凝血酶组1年通畅率为82%，肝素组为50%（P<0.05）。因此，激光血管成形术与抗凝血酶是非常有用的预防急性再闭塞和再狭窄。少

Thrombogenicity and proliferative effects of laser angioplasty was compared with balloon angioplasty in 8 dogs. Mean percent area stenosis by thrombus was 62 (]SY.+-[) 28 in balloon dilated, 31 (]SY.+-[) 29 in laser thermall treated and balloon dilated, 5 (]SY.+-[) 6 in laser thermal-treated, and 1 (]SY.+-[) 2 in directly lased segments at 60 minutes (P<0.0005 vs balloon). In 8 atherosclerotic rabbit iliac arteries, mean luminal diameter increased from 0.19 to 1.54 mm by laser thermal and from 0.29 to 1.84 mm by balloon (P<0.0001, repectively). However, due to thrombotic reobstruction, it decreased to 1.34 for laser and 0.45 for balloon (P<0.0001 vs immediately post) at 60 minutes later. Thus laser thermal angioplasty results less thrombogenecity than balloon angioplasty.We investigated preventive effect of laser angioplasty on restenosis in hypercholesteremic rabbits. One side of atherosclerotic iliac stenosis was dilated by balloon and the other by laser angioplasy. Following angiopl … More asty, luminal stenosis increased from 16 to 58% in balloon-dilated arteries (P<0.05), whereas, it changed from 26% to 30% in laser thermal group and from 28 to 39% in direct laser group. The results suggested that laser angioplasty may prevent restenosis after angioplasty.Thrombogenicity of pulsed laser treated arteries were evaluated in rabbits. Angioscopic mean percent obstruction with thrombus was 8.6 % with laser thermal treatment, and 41.9 % with control balloon (n=7, P<0.0001) at 1 hour after the treatment. It was 3.8 % with excimer and 51.9 % for the control balloon group (n=8, P<0.001). Angioscopic percent luminal obstruction was 1.4 with excimer, 2.6 with holmium YAG,2.5 with Nd-YAG and 49 for balloon angioplasty group (P<0.0001). The results suggested that pulse laster treatment can also reduce thrombogenicity.One side of iliac stenosis was dilated by balloon and the other artery was dilated by laser angioplasty in 18 dogs. Before angioplasty, antithrombin or heparin was infused in 10 dogs. One hour after angioplasty, mean thrombotic stenosis was 62% in balloon control, and 5% in laser thermal group. It was 8.6% in balloon with heparin, 1.2% in laser with heparin, and 0% in laser with antithrombin. The results suggested that adjunctive antithrombotic therapy to laser treatment can completely prevent thrombosis.We investigated laser thermal angioplasty in 27 patients with arteriosclerosis obliterans, and succeeded in 21 patients. With antithrombin therapy, one year patency was 82%, compare with 50% with heparin (P<0.05). Thus laser angioplasty with adjunctive antithrombin is very useful for prevention of acute reocclusion and restenosis. Less