旋磨联合支架治疗31例严重钙化冠状动脉的临床特点分析

Clinical Characteristics of Rotablation Atherectomy with Drug-eluting Stents for 31 Severe Coronary Calcification Lesions

目的评估严重钙化冠状动脉行旋磨联合药物洗脱支架的临床疗效。方法通过回顾性分析31例因严重钙化冠状动脉行旋磨介入治疗的患者,其中13例在血管内超声(IVUS)指导下进行,分析其临床特点,观察手术即刻成功率、住院期间及长期心血管事件随访结果。结果 31例患者平均年龄71.81±10.70岁,其中男性22例,女性9例,经造影证实为严重钙化冠状动脉,其中造影证实单支病变2例(6.5%),双支病变7例(22.6%),三支病变15例(48.4%),左主干+三支病变1例(3.2%),左主干病变6例(19.4%)。旋磨靶血管中左主干-左前降2例(6.5%),左前降支22例(70.9%),左回旋支2例(6.5%),左前降支+左回旋支1例(3.2%),右冠状动脉4例(12.9%)。术中需主动脉球囊反搏保护1例(3.2%),冠状动脉夹层6例(19.4%),慢血流2例(6.5%),但31例患者均成功实施了旋磨及支架植入术,术前、术后血肌钙蛋T、血清肌酸激酶同工酶、血肌酐无统计学差异。13例(41.9%)在IVUS指导下进行,患者术前、术后管腔最小直径、最小直径狭窄率、管腔有效面积有显著差异,分别为2.0±0.3 mm比3.6±0.8 mm、74.5%±6.8%比20.3%±12.5%、4.0±1.4 mm2比10.7±5.5 mm2(P=0.000),平均随访10.4±6.4个月,随访期间无心绞痛、急性心肌梗死、心源性猝死、靶血管再次血运重建事件发生。结论冠状动脉内旋磨术联合药物洗脱支架治疗严重钙化病变可以去除或减轻钙化斑块、增大管腔,最终提高严重钙化病变介入治疗的成功率。

Aim To assess the efficiency of rotational atherectomy （RA） with drug-eluting stents （DES） for heavily calcified lesions. Methods By retrospective analysis of 31 cases of severe calcified coronary atherectomy with interventional treatment of patients, 13 patients were carried out under the guidance of intravascular ultrasound （IVUS）, and we analyzed the clinical characteristics, immediate success rate of percutaneous coronary intervention （PCI）, and cardiac events of hospitalization and long-term follow-up results. Results The mean age of 31 patients was 71.81 ± 10.70 years, and 22 patients were male, 9 patients were female. Their coronary artery were confirmed as severely calci- fied coronary by angiography, including single-vessel disease in 2 cases （ 6. 5% ）, double vessel disease in 7 cases （22. 6% ）, three lesions in 15 cases （48.4%）, left main （LM） ＋ three lesions in 1 case （3.2%）, LM disease in 6 ca- ses （ 19. 4% ）. Rotational atherectomy target vessel in LM-left anterior descending artery （LAD） was 2 cases （6. 5 % ）, LAD was22 cases （70. 9% ）, left circumflex artery （LCX） was2 cases （6. 5% ）, LAD ＋LCX was 1 case （3.2%）, right coronary artery （RCA） was 4 cases （ 12.9% ）. 1 case （3.2%） needed intra-aortic balloon pump （IABP） intraoperation, 6 cases （ 19.4% ） were presented with coronary dissection and 2 cases （6.5% ） were with slow flow, but all of them were successfully implemented with rotational atherectomy and stent implantation. Serum troponin T, serum creatine ki-nase-MB, and serum creatinine had no significant difference. 13 cases were carried out by IVUS, and the minimum lumen diameter, the smallest diameter stenosis rate, the effective area of ？7 the lumen had significantly statistical difference preand post-operative, respectively（2. 0 ＋0. 3 mm vs 3.6 ±0. 8 mm, 74. 5% ±6. 8% vs 20. 3% ± 12. 5%, 4. 0 ＋ 1.4 mm2 vs 10.7 ± 5.5 mm2, P = 0. 000）. With an average follow-up 10. 4 ±6.4 months, no angina, acute myocardial infarction, sudden cardiac death, target vessel revascularization occurred. Conclusions The combination of rotational atherectomy with stents may selectively ablate calcific plaque and may increase the success rate of the PCI.