选择检查方法的重点在于你选择的是否是最合适的技术,可以选择的有CT血管造影CTA(而不是MRA)或数字剪影血管造影。到目前为止我们发现MRA是非常好的技术但是这种检查方法会漏掉很多狭窄病变。
International Circulation: If you are talking about intervening early on, does this mean we should be starting with medical therapy which gives that therapy time to have an effect and if stenosis worsens then take the next step to a percutaneous intervention or should we be going to angioplasty right away?
Dr de Leeuw: Maybe we should be doing the angioplasty or stenting at an earlier stage. We are trying to set up a trial now to determine if that turns out to be true.
《国际循环》:如果您的意思是早期干预,是不是说我们应该在有治疗效果的时候进行药物治疗并且当狭窄程度加重就该进行下一步治疗即经皮介入治疗,还是我们应该一开始就选择血管成形术?
Dr de Leeuw:可能我们应该在早期进行血管成形术或支架植入治疗。目前我们正在准备进行一项临床试验来证实这种结论的可靠性。
International Circulation: In the trial, you would be comparing medical therapy to stenting?
Dr de Leeuw: Yes, in patients with low-grade stenosis.
《国际循环》:在这个试验里,您会把药物治疗和支架治疗的效果进行对比吗?
Dr de Leeuw:对,我们会对轻度肾动脉狭窄患者在这两种治疗情况下进行对比。
International Circulation: Why do you think it might be better to go straight to a stent?
Dr de Leeuw: Look at it this way, if you have a washing machine at home and you have a lot of calcification in the plumbing of the machine, you could wait until your machine is not working anymore or you could clean the tubing before the machine gets damaged. That is the way of thinking. If you intervene at an earlier stage, you keep the perfusion of the kidney at a normal level and we think we can prevent the deterioration of renal function.
《国际循环》:为什么您认为直接进行支架植入治疗可能更好?
Dr de Leeuw:可以这样说,如果你家里有洗衣机而洗衣机的管道里有很多钙化,你会等到洗衣机完全不能运转时再清理管道还是在机器损坏之前就清理管道。这就是关于这个问题的思维方式。如果在早期进行介入治疗,就能使肾脏灌注达到正常水平并且我们认为这种方法能阻止肾功能的恶化。