| Background and Objectives: Percutaneous coronary intervetion (PCI) has become a well-established tachique for myocardial revascularization of patients with coronary artery disease. Despite a primary success rate is great, acute and subacute thrombosis is still associated with a high risk of death and nonfatal myocardial infarction, and the long-term benefit continues to be compromised by the recurrence of stenitic lesions. Over the past several years the rate of Restenosis(RS) after percutanenous transluminal coronary angioplasty(PTCA) is higher than expected. RS affects 30% to 50% of treated patients within 3 to 6 months. Recent studies have demonstrated that the injury of endothelium is the startup factor of restenosis. Balloon angioplasty typically injures the vessel wall by inducing irregular intimal tears, splits and stretches. The dissection of endothelium exposes collagen and lipid to blood, which caninduces changes in expression of coagulation and fibrinolysis factors, as well as activation of platelets. Activation of platelets results in early thrombin generation, leading to release of various vasoactive substances and growth factors. In addition, thrombus formation is believed to play an important role in the pathogenesis of abrupt vessel occlusion after coronary angioplasty and possibly late restenosis. The Cutting Balloon is a novel dilatation catheter for coronary angioplasty. It is a new balloon angioplasty device. The longitudinal incisions of plaque and vessel wall reduce true dissection rates as well as nominal vessel area decrease. Thus, Cutting Balloon angioplasty(CAB) may limit the degree of traumatic vessel wall injury, typically encountered in plain old balloon angioplasty (POBA). However, the mechanism by which the trauma is beneficial and whether the trauma redution leads to decreased restenosis rate are still to be clinically established. We study the platelet activation in coronary sinus blood induced before and after CBA as well as its clinical significance.Methods: 57 hospitalized patients from October, 2001 to December, 2002 were enrolled for either cutting balloon angioplasty(group CBA, 31 patients) or plain old balloon angioplasty (group POBA, 26 patients) in our study. Stents were installed after balloon angioplasty. Blood was obtained from the coronary sinus, respectively, before angioplasty, and 1 minute after the fast inflation, and 10 minute after, 30 minute after angioplasty. Bioassay method for PDGF assessment. The levels plasma vWF and 6-k-PGF1a.were determined using ELISA.Results:I.Basic information:There was no significant difference of the age, gender, disease type, laboratory parameters except hypertension between two groups. Image analysis also suggest that there was no no significant difference of pathological changes, narrow type and the size or lenth of stent between two groups.2.The concentration of vWF was significantly increased after angioplastyin all groups(P<0.05).Moreover, vWF kept on a lower lever at the end of PTCA in the CBA group than the POBA group(P<0.05).3.The amount of 6-k-PGFi?were impermanently decreased after PTCA in all groups (P<0.05),recovering to the normal at 10 minutes in the CAB group, while at 30 minutes in the POBA group.4.The amount of PDGF were significantly increased after PTCA between the CBA group and the POBA group (P<0.05). Moreover the amount of PDGF was higher after PTCA than that before PTCA, steadily increasing at 30 minutes. The amount of PDGF lever was lower after PTCA in the CAB group than that in the POBA group.Conclusion:1. The lesion induced by CBA associated with stents implantation or POBA associated with stents implantation could lead to activation of platelet.2. CBA associated with stents implantation could lighten the activation of platelet in coronary sinus compared with POBA associated with stents implantation. Cutting balloon angioplasty produced more gently irritation to platelet activation and thrombosis than plain old balloon angioplasty.3. The beneficial effec... |
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