药物支架时代冠状动脉旋磨术治疗严重钙化病变63例分析

Rotational atherectomy followed by drug-eluting stent implantation in calcified coronary lesions in 63 cases

目的探讨在药物支架时代冠状动脉旋磨术治疗冠状动脉钙化病变的安全性及有效性。方法连续收集自2008年3月1日至2011年12月31日的本院单中心63例行冠状动脉旋磨术的患者资料,并回顾分析临床资料,手术成功率及临床效果和主要心血管事件(心源性死亡、心肌梗死和靶病变重建)的发生率。结果 63例患者共有66处钙化病变,63例患者中5例为急性心肌梗死(7.9%);58例为不稳定型心绞痛(92.1%)。17例(27%)合并糖尿病,52例(82.5%)合并高血压。66处病变中60处(90.9%)旋磨联合球囊扩张及DES支架植入,4处(6.1%)旋磨加球囊扩张未植入支架,2处(3.0%)仅旋磨,未植入DES支架是由于血管直径<2.25 mm。手术成功率为96.8%。1例残余狭窄大于50%,另1例左主干患者术后12小时心源性死亡,考虑为可能性支架血栓形成。所有患者随访8～12个月。有2例再发心绞痛,无主要心血管事件(包括心源性死亡、心肌梗死、靶病变血运重建)发生。结论在药物支架时代,冠状动脉旋磨术联合球囊扩张和支架植入术治疗冠状动脉钙化病变是治疗钙化病变安全、有效的方法,可取得很高的手术成功率。

Objectives To investigate the safety and efficacy of coronary rotational athemctomy in the treatment of coronary artery calcification lesions at our hospital in the DES era.Methods Consecutive cases involving RA between March 1,2008 and December 31,2011 at a single-center were reviewed retrospectively.Procedural success rate and clinical effect of postoperative visiting and main adverse cardiovascular events(including cardiac death,myocardial infarction and target lesion revascularization)were recorded and focused on.Results 63 patients with 66 de novo severely calcified lesions were described,Including 5 patients with AMI(7.9%);58 patients with unstable angina(UAP)(92.1%).17 patients(27%) had diabetes mellitus and 52 patients(82.5%) had hypertension.66 lesions were described,including 60 lesions(90.9%) with RA and subsequent PTCA and DES implantation,4 lesions(6.1%) with RA and PTCA no stent,2 lesions(3.0%) with RA no PTCA and stent,DES were not placed due to reference vessel diameter <2.25mm.Procedural success rate was 96.8%.One case had more than 50% rest stennosis,the other case with LM lesion dead due to possible stent thromboses 12 hours after procedure.Angina was appeared in 2 cases and no major adverse cardiac events(including cardiac death.myocardial infarction and target lesion revascularization) occurred during follow-up for 8-12 months.Conclusion In the DES era,Coronary rotational atherectomy combined with PTCA and stent implantation was effective and safe in the treatment of coronmy artery calcification lesions.It presented a high procedural success rate.