Cutting-balloon angioplasty before drug-eluting stent implantation for the treatment of severely calcified coronary lesions

BackgroundSeverely 钙化的冠的损害对汽球 angioplasty 糟糕作出回应，导致不完全、不均匀的 stent 扩大。因此，在 drug-eluting stent (DES ) 以前的足够的匾修正培植是为钙化的损害治疗的钥匙。这研究是评估为严重地钙化的冠的 lesions.MethodsNinety 切汽球 angioplasty 的安全和功效 -- 有严重地钙化的损害的二个连续病人(定义为钙弧 ≥；180 °；钙长度比率 ≥；0.5 ) 在 DES 培植随机基于汽球类型被划分成二个组以前，与汽球膨胀对待：在常规汽球 angioplasty (BA ) 的 45 个病人组织，在切的汽球 angioplasty (CB ) 的 47 个病人组织。在 BA 组的七个盒子令人满意地没完成膨胀并且被变成 CB 组。 Intravascular 超声( IVUS )在汽球膨胀前并且在 stent 培植以后被执行获得质、量的损害特征并且评估 stent ，包括最小的腔代表性的区域( CSA )，钙化的弧和长度，最小的 stent CSA ， stent 并置， stent 对称， stent 扩大，容器解剖，并且分叉容器监狱。在里面医院， 1 月、 6 月的主要不利心脏的事件(向) 是 reported.ResultsThere 不是在在二个组之间的临床的特征的统计差别，包括钙弧(222.2 °；±；22.2 °；对 235.0 °；±；22.1 °；， P = 0.570 ) ，钙长度比率(0.67 ±；0.06 对 0.77 ±；0.05， P = 0.130 ) ，并且在一种总线标准前的最小的腔 CSA (2.59 ±；0.08 公里 2 对 2.52 ±；0.08 公里 2, P = 0.550 ) 。在 stent 培植以后，最后的最小的 stent CSA (6.26 ±；0.40 公里 2 对 5.03 ±；0.33 公里 2 ；P = 0.031 ) 并且尖锐的腔获得(3.74 ±；0.38 公里 2 对 2.44 ±；0.29 公里 2, P = 0.015 ) 比 BA 组的在 CB 组是显著地更大的。没有统计上在在二个组之间的 stent 扩大， stent 对称，不完全的 stent 并置，容器解剖和分支容器监狱的差别。在在严重地钙化的损害的 DES 培植看起来是包括显著地更大的最后的 stent CSA 和更大的尖锐的腔获得的更多的功效以前， 30 天、 6 月的向率也不是 different.ConclusionsCutting 汽球 angioplasty，没有增加在操作和 MACE 率在期间的复杂并发症 6 月。

Background Severely calcified coronary lesions respond poorly to balloon angioplasty, resulting in incomplete and asymmetrical stent expansion. Therefore, adequate plaque modification prior to drug-eluting stent （DES） implantation is the key for calcified lesion treat- ment. This study was to evaluate the safety and efficacy of cutting balloon angioplasty for severely calcified coronary lesions. Methods Ninety-two consecutive patients with severely calcified lesions （defined as calcium arc 〉 180% calcium length ratio 〉 0.5） treated with bal- loon dilatation before DES implantation were randomly divided into two groups based on the balloon type： 45 patients in the conventional balloon angioplasty （BA） group and 47 patients in the cutting balloon angioplasty （CB） group. Seven cases in BA group did not satisfactorily achieve dilatation and were transferred into the CB group. Intravascular ultrasound （IVUS） was performed before balloon dilatation and after stent implantation to obtain qualitative and quantitative lesion characteristics and evaluate the stent, including minimum lumen cross-sectional area （CSA）, calcified arc and length, minimum stent CSA, stent apposition, stent symmetry, stent expansion, vessel dissection, and branch vessel jail. In-hospital, 1-month, and 6-month major adverse cardiac events （MACE） were reported. Results There were no statistical differences in clinical characteristics between the two groups, including calcium arc （222.2° ± 22.2° vs. 235.0° ± 22.1 °, p=0.570）, calcium length ratio （0.67 ± 0.06 vs. 0.77± 0.05, P = 0.130）, and minimum lumen CSA before PCI （2.59 ±0.08 mm2 vs. 2.52 ± 0.08 mm2, P = 0.550）. After stent implantation, the final minimum stent CSA （6.26 ± 0.40 mm2 vs. 5.03 ± 0.33 mm2; P = 0.031） and acute lumen gain （3.74 ±0.38 mm2 w. 2.44 ± 0.29 mm2, P = 0.015） were significantly larger ila the CB group than that of the BA group. There were not statis tically differences in stent expansion, stent symmetry, incomplete stent apposition, vessel dissection and branch vessel jail between two groups. The 30-day and 6-month MACE rates were also not different. Conclusions Cutting balloon angioplasty before DES implantation in severely calcified lesions appears to be more efficacies including significantly larger final stent CSA and larger acute lumen gain, without increasing complications during operations and the MACE rate in 6-month.