冠状动脉旋磨术联合药物洗脱支架治疗冠状动脉严重钙化病变的临床研究

Clinical Investigation of Rotational Atherectomy Combining Drug-Eluting Stents Treating the Patients With Severe Coronary Artery Calcified Lesions

目的:评价冠状动脉旋磨术(rotational atherectomy,ROTA)联合药物洗脱支架(drug eluting stent,DES)治疗冠状动脉严重钙化病变的疗效及中期随访结果。方法:对2009-01至2011-02连续的24例冠心病患者严重钙化病变行ROTA加DES治疗,其中经股动脉路径14例,经桡动脉路径10例,观察其旋磨特点、即刻造影成功率、临床成功率、院内事件发生率和平均随访12个月(6～24个月)的结果。结果:行ROTA的患者均为美国心脏病学会/美国心脏病协会(AHA/ACC)B2/C型严重钙化病变。旋磨头均成功通过狭窄病变,并完成DES置入术,91.7%(22/24)的病例最后使用≤1.5 mm旋磨头通过钙化病变,总成功率为100%,术中仅1例发生慢血流和心动过缓,院内无非Q波心肌梗死发生,无冠状动脉穿孔、急诊冠脉旁路移植术及死亡发生。随访期间无主要心脏不良事件(MACE)。结论:选用直径较小的旋磨头改变钙化病变的血管的顺应性后,可以顺利完成DES植入术,中期效果满意。

Objective ：To investigate the clinical efficacy of rotational atherectomy （ROTA） combining drug eluting stents （DES） trea- ting the patients with severe coronary artery calcified lesions. Methods ： We retrospectively summarized 24 consecutive coronary artery disease patients with severe calcified coronary lesions treated by ROTA combining DES in our hospital from 2009 to 2011.14 patients received DES via femoral artery and 10 via radial artery. We studied ROTA procedural characteristics,immediate success rate,the in-hospital and mean 12 months （6 -24 months） follow-up results for major adverse cardiovascular events （MACE） in all patients. Results ： All calcified lesions were at B2/C type according to AHA/ACC definition. All patients successfully completed ROTA followed by DES implantation ,the immediate procedural success rate was 100% , and 91.7% （22/24）patients used the burr size ≤ 1.5mm. Only 1 patient suffered from slow flow and bradycardia. There were no in-hospital none-Q wave myocardial infarction, no coronary perforation, no one needed emergent CABG and no in-hospital death. No patient had MACE during the follow-up period of time. Conclusion：Using smaller size burr could facilitate DES implantation and achieve satisfied mid-term results in patients with severe calcified coronary lesions.