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经皮冠状动脉腔内成形术(PTCA)分先施行冠状动脉内溶栓法(PTCR),再加用PTCA的即刻PTCA(iPTCA);以及不施行PTCR,直接进行PTCA 的直接PTCA(dPTCA)。现介绍如下:一、直接经皮冠状动脉腔内成形术作者对施行紧急冠状动脉造影示完全或几乎完全闭塞,临床情况无明显差异的两组病例,比较PTCR 和PTCA 的疗效;再通率,PTCR 为74%,dPTCA为80%,死亡率,PTCR 为9.3%,dPTCA 为5%。全部死亡病例再灌注前均系冠状动脉完全闭塞且缺乏侧枝循环者。再通后的早期再闭塞PTC2 组为18%,而PTCA 组则没有发生。3～4周后,施行左室造影,用记分法评价室壁运动。结果发现:从发病到施行dPTCA的时间越长,室壁运动越差。dPTCA 较PTCR的优点为:①再通率高,②死亡率低,③早期再闭塞少,④改善慢性期心功能好。目前认为PTCA 的适应证主要是冠状动脉内溶栓失败或残留狭窄的患者。
Percutaneous transluminal coronary angioplasty (PTCA) followed by intracoronary thrombolysis (PTCR) followed by PTCA with immediate PTCA (iPTCA); and direct PTCA without PTCR (dPTCA). Are described below: First, the direct percutaneous transluminal coronary angioplasty The implementation of emergency coronary angiography showed complete or almost complete occlusion, no significant clinical difference between the two groups of patients to compare the efficacy of PTCR and PTCA; recanalization rate, PTCR was 74%, dPTCA was 80%, and mortality was 9.3% for PTCR and 5% for dPTCA. All cases of death before coronary artery occlusion were completely occluded and lack of collateral circulation. After recanalization, the early reocclusion of PTC2 group was 18%, while the PTCA group did not occur. After 3 to 4 weeks, left ventricular angiography was performed and wall motion was assessed using scoring method. The results showed that: from the onset to the implementation of dPTCA longer, worse wall motion. The advantages of dPTCA over PTCR are: ① high re-pass rate, ② low mortality, ③ early re-occlusion less, ④ improve cardiac function in chronic phase. It is currently believed that the indications for PTCA are mainly those patients who fail or have residual stenosis in their coronary arteries.