－－介入治疗30年历程
Schatz Recalls Early Days of Angioplasty--30 YEARS of ANGIOPLASY 

　　Richard A. Schatz医生在冠心病介入治疗领域众所周知，他是第一个商业化冠脉支架－Palmaz-Schatz 支架的共同发明者，该支架用于预防球囊扩张后再狭窄，直至今日他的研究工作仍对介入心脏病学领域的革命起着重要的引导作用。

　　Schatz医生现在是加利福尼亚心脏、肺脏和血管中心，心导管室主任和心血管介入研究负责人。

　　在1981年，Schatz参加了由Andereas Gruentzig 博士主持的血管成形教程，Andereas Gruentzig是这一技术的发明者。“这一课程极为引人入胜，因为Gruenzig 本人极为辉煌，他的课程也深受欢迎；并且他正从事的工作如此异端且富有争议，以至于作为听众你也感到紧张与不安。这也是引起了极大兴趣之处，”Schatz 说。

　　危险的操作过程

　　“人们已经忘记在当时血管成形是多么危险。但对于那4或5个最终走进手术室完成了冠脉重建的患者而言却极不寻常。即使在手术过程中…….听众中有人情不自禁大叫，“取出球囊吧，快排空球囊吧，否则，你会把患者搞死的。”
“这就是当时所发生的真实一幕，太刺激了。”

　　Schatz心悬一线，他说服他的导师会在他所工作的部队医院开始血管成形术。做首例手术的前夜，他忐忑不安。“过了很长时间才平静下来，”他说。

　　早期的器械十分简陋。“我们只有一根Guiding导管，且导管尖端很硬，边缘锐利，十分危险，我们需将它送到左主干，送到右冠，这是我们今天不敢想象的事，”Schatz说。

　　“导丝上缚有一个球囊，你甚至无法得到一个直径和长度都合适的球囊。你也不可能用其他器械替代，甚至球囊扩张装置也十分原始。

　　“我们使用的是以CO2为弹药的金属枪，当你扣动板机的时候，CO2就会喷射出来。它们会充盈球囊，随即你就应当抽瘪球囊。有时球囊却无法抽空。”

　　随机应变

　　在早期的血管成形操作中，Schatz经常要随机应变。他描述了他和同事们如何口服硝酸甘油片，将其嚼碎，通过细小的过滤口倒出并将溶液抽入注射器中。“然后我们将其推入冠脉中，”Schatz说。“因此，依据目前的标准，我们的所作所为不可思议，简直是发了疯。”
　　
　　他记得成功率在60－70%之间，再狭窄率为50%。

　　“这些成就太辉煌了，当我们看到患者在几天后离开医院时，我们感到无论这一技术多么危险，也不管它多么复杂，它确实成功地解决了问题，”Schatz 说。

　　“并且，的确，这也是每年都在发生的奇迹。这一技术也变得越来越简便，安全，有效。”

　　（阜外心血管病医院 高立建 宋会军　编译）

Schatz Recalls Early Days of Angioplasty--30 YEARS of ANGIOPLASY 

Richard A. Schatz, MD, is best known as the coinventor of the first commercially available coronary stent, the Palmaz-Schatz stent, developed to prevent restenosis after balloon angioplasty. His research ushered in a revolution in interventional cardiology that continues today.

Schatz is now the director of the Cardiac Catheterization Laboratory and research director of Cardiovascular Interventions at the Heart, Lung and Vascular Center at Scripps Clinic in La Jolla, Calif.

In 1981, Schatz attended a course on balloon angioplasty conducted by the inventor of the technique, Andreas Gruentzig, MD. “It was really spectacular because Gruentzig had such a flare that he made it entertaining, and he was doing something that was so heretical and controversial that you could just sense the tension in the audience. That’s really what got my attention,” Schatz said.

A risky procedure

“People forget how risky angioplasty was then, but it was not unusual for four or five patients to end up going to the operating room and having CPR done because of an abrupt closure. Even during the procedures...someone from the audience would yell out, ’Take the balloon down, deflate the balloon, you’re going to kill him.’
“These were real things that hap¬pened, and it was exciting.”

Schatz was hooked. He convinced his boss to start doing angioplasties at the army hospital where he worked. The night before his first case, he was terrified. “It took a long time for that feeling to go away,” he said.

The early equipment was primitive. “We only had one guiding catheter, and it had no soft tip. It had a real sharp edge. The leading edge was very dangerous, and we’d be pushing that thing into the left main, into the right coronary, things we would never think of doing today,” said Schatz.

“It was a balloon on a wire, and you couldn’t even get the right bal¬loon. You couldn’t get the right size, the right length. They were hard to come by, and even the inflation equipment was almost prehistoric.

“We had this metallic gun with these CO2 cartridges, and you’d have to pull a trigger and the CO2 would blast off. It would open up the balloon, and then you’d have to deflate it really quickly. Sometimes the balloons wouldn’t even deflate.”

Improvisation needed

During his first angioplasties, Schatz often improvised. He described how he and his colleagues would take nitroglycerin tablets, grind them up, pour them through a miniport filter and then let the solution drip into a syringe.

“Then we would blow that down to the coronary,” Schatz said. “So by today’s standards things were absolutely prehistoric, almost barbaric.”

He recollects success rates in the range of 60% to 70%, with 50% restenosis rates.

“The successes were so grand that when we saw patients leave the hospital in a few days, [we felt] that whatever risks or whatever complications there were, they were solvable problems,” Schatz said.

“And, indeed, that is what has happened every year. It gets easier and safer and better.”