因冠状动脉壁具有弹性，当球 囊导管使其过度牵张后，将会发生 弹性回缩。一般在PTCA术后数 秒～数分发生。
PTCA
Artery with atherosclerotic
plaque
Elastic recoil
二、血栓形成
Thrombus Formation
Angioplasty
Endothelial Media denudation dissection
Percutaneous Transluminal Angioplasty (PTA)
Interventional radiology
1974年： 瑞士医生Gruentzig成功进行了经 皮冠状动脉腔内成形术
Percutaneous Transluminal Coronary Angioplasty (PTCA)
1996年：
美国每年约有50万人接 受PTCA手术治疗。
2001年：
全球每年约有150万人 接受PTCA手术治疗。
1984年： 我国实施了首例 PTCA手术。
截止1996年：
我国共实施了5209例 PTCA手术。
二、 PTCA治疗机制
Mechanism of Luminal Enlargement
Exposure of subintimal components
Tunica interna Endothelium Basement membrane
Internal elastic lamina Tunica media External elastic lamina Tunica externa
Adventitia
Media
The arrow indicates the internal elastic lamina (IEL).
第二节 再狭窄发生机制
Pathogenesis of Restenosis
一、弹性回缩
Elastic Recoil
人类冠状动脉虽为肌性动脉， 但含有弹性纤维：
内弹力板( Internal Elastic Lamina，IEL)
外弹力板( External Elastic Lamina，EEL)
(Transluminal Extraction Catheter Atherectomy )
Coronary Stents
1986 Sigwart
1994
STRESS trial: Stent Restenosis Study(USA)
BENESTENT trial: Belgium Netherlands
血管成形术后再狭窄
Restenosis after Angioplasty
病理生理学教研室： 刘洁
第一节 概 述
Introduction
冠心病的治疗
药物治疗 手术治疗 介入治疗
一、历史回顾 History Retrospect
1954年：
美国放射学家Doter开创经皮血 管腔内成形术
Stent Trial (Europe)
Restenosis occurs approximately 15～ 20% within 6 months after intervention sometimes necessitating repeat revascularization.
Stenting after PTCA indeed reduces the incidence of restenosis.
following PTCA
Structure of human coronary artery
Tunica interna(intima)
Endothelium Basement membrane
Internal elastic lamina(IEL) Tunica media(media) External elastic lamina(EEL) Tunica externa(adventitia)
Loss of ≥50% of the initial gain in lumen size produced at angioplasty.
or
A ﹥50% stenosis at follow-up angiography.
Clinical Restenosis
Recurrence of symptoms or adverse events，usually death， non-fatal myocardial infarction， or need for revascularization.
1.粥样斑块破裂(Plaque Rupture) 2.内皮剥脱(Endothelial Denudation) 3.内膜断裂(Intimal Disruption)
4.内弹力板撕裂
(Fracture of Internal Elastic Lamina)
5.中膜分离移位(Dissection of Media)
Intima Media AdventiБайду номын сангаасia
ANGIOPLASTY
Intimal and medial tears
PTCA
Artery with atherosclerotic
plaque
Lumen size increased
三、 PTCA局限性
Limitations of PTCA
急性血管闭塞约1%～5%。 术后3-6个月内再狭窄约25%～50%。
五、 再狭窄的概念
Concept of Restenosis
Histological Restenosis
The renarrowing can be seen histologically but not angiographically and is clinically silent.
Angiographic Restenosis
四、 PTCA的发展
Development of PTCA
冠状动脉内膜支架术(Coronary Stenting)
冠状动脉定向旋切术 ( Directional Coronary Atherectomy )
冠状动脉内膜旋磨术( Coronary Rotablation )
冠状动脉内膜切吸术