INTERNATIONAL CIRCULATION: In viewing the evolution of angioplasty and stenting， in 2011， what are the current indications for those procedures?
　　国际循环：我们在2011年见证了血管成形术和支架植入术的进展，请问这些手术目前的适应症有哪些?
　　Dr Bailey: Well angioplasty alone， balloon angioplasty is done relatively infrequently. It constitute 7-12% of the procedures that are done. Typically now， we do it either in patients who have contraindications to long-term anti-platelet therapy or presented with an acute myocardial infarction you do the angioplasty and make a decision for other reasons that you want to or need to do anything more definitive. Or in branch vessels where you’re talking (about) smaller balloons and outcomes， bifurcations in which balloon angioplasty alone is effective. For stents， I think the indications are pretty clear -- that in individuals who have lifestyle limiting angina， despite medical regimens -- either they can’t tolerate the regimens or hopefully they’re on the appropriate current medical regimens for optimum medical therapy - those individuals should proceed. I think it’s more controversial as we talk about those individuals who have large amounts of myocardium at risk， either with open vessels or those who have chronically closed vessels， particularly in the LAD distribution， because we do have data that says chronically occluded LAD improves survival.
　　Bailey医生：单纯的血管成形术，球囊扩张做的相对较少。大约占手术总数的7%～12%。现在，这类手术通常的对象要么是对长期抗血小板治疗存在禁忌证的患者，要么是急性心肌梗死患者，你实施了血管成形术，并由于其他原因下定决心做你想要或者需要做的更确切的事。在分支血管中，你需要较小的气囊和效果，在分支中单用气囊成形术就非常有效了。对于支架来说，我认为适应症非常清楚，即尽管有医疗方案，但仍然存在影响个人生活状态的心绞痛的患者--要么患者不能耐受该方案，要么希望他们当前适用的医疗方案是最佳治疗方法--这些患者应该接受这一治疗。我认为，大量心肌存在风险的患者更有争议性，他们要么存在出血风险要么存在慢性血管闭塞，特别是左前降支分配区，因为我们确实有数据显示慢性左前降支闭塞能够改善生存率。
　　INTERNATIONAL CIRCULATION: In patient with femoral popliteal artery disease， we talk about safety and efficacy of atherectomy in those patients.
　　国际循环：下面请您谈一谈对于存在股腘动脉疾病的患者，旋切术的安全性和有效性如何？
　　Bailey医生：对于髋关节到膝关节之间或者膝关节到踝关节之间存在动脉血管疾病的患者，他们的病变通常是弥漫性的，该类患者往往存在更多的钙化性疾病，闭塞管腔的斑块也更多。我们在多年前已经了解到，通过一次气囊成形术或者即使是植入支架来使初次疗效具有持续性是非常困难的。所以，能够移走一些斑块或者再次打开血管或者调整血管是至关重要的，当治疗完成时，能让血管扩展到更大的直径。因此，所有现在正在使用的旋磨术，定向旋切术，激光旋切术，均符合其设计的初衷，成为了便利的疗法。它们能够协助我们进行一个确定性的手术，比如支架植入或者让我们有能力初次打开血管，以便稍后能再回来进行肯定的治疗。所以，该类疗法确实起到了辅助性的作用，而并不是主要治疗方式，但是它们的确能够带来很大益处。缺点是如果患者存在较大量的斑块和较大量的血栓，有可能治疗过程中一些斑块和血栓会发生脱离并下行进入腿部，这一发生率是值得注意的，显著占到2，3，4，5%。这一显著性将使人们出于防范性的目的放置栓子保护过滤器，尤其是对于采用大型旋切术设备的患者，因为你不希望这些东西进入较小的远端血管。所以采用栓子保护装置拦截栓子是这一疗法的重要组成部分。
　　Dr Bailey: So individual that have disease of the arteries of the leg， between the hip and the knee， or from the knee down to the ankle， often have diffuse disease， they tend to have more calcific disease， and they tend to have more plaque occluding the lumen. And we have learned over the years that it is much more difficult to have a sustained first affect from either a balloon procedure or even stents. So the ability to remove some of that plaque， either to reopen the vessel or to modify the vessel so that it expands to a larger diameter when you’re finished has been critically important. So rotational atherectomy， directional atherectomy， and laser atherectomy -- all have been used -- like coron they are designed as facilitative therapies. They facilitate your ability to have a definitive procedure such as a stent or to have the ability to open the vessel initially so that you can return at a later date and definitely treat it. So their roles really are assistive rather than as a primary treatment， but they are clearly beneficial. The downside is that with larger amounts of plaque， larger amounts of thrombus， that the opportunity for some of that plaque and some of that thrombus to escape and move down into the leg， is significant， significant being 2， 3， 4， 5%. Significant to the point where people will， particularly with the large atherectomy devices， put in embolic protection filters for the same reason we do in parotids， you want that material not to find its way into smaller distal vessels. And so trapping that with embolic protection can be one important part of that strategy.
　　INTERNATIONAL CIRCULATION: Dr Bailey， thank you very much.
　　国际循环：非常感谢您，Bailey医生。
　　Dr B: You are quite welcome
　　Bailey医生：您太客气了。

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