冠状动脉旋磨术在复杂病变介入治疗中的应用

Rotational atherectomy in complex coronary artery lesions

目的 :探讨冠状动脉旋磨术 (Rotationalatherectomy)治疗复杂冠脉病变的策略及效果。方法 :对 79例患者的 86处病变行冠脉旋磨治疗 ,观察其治疗的即刻成功率及并发症率。结果 :79例施行冠状动脉旋磨术的患者 ,旋磨头均成功地通过了病变 ,手术成功率为 96 .2 0 % (76 79) ,平均狭窄程度由87 4%± 8.78%降至 14.6 %± 10 .89%。其中 5 9.49%的病例选择了 1.5mm的旋磨头 ,2 7.88%的病例使用了二个旋磨头。全部病例均联合应用了冠脉球囊扩张术 ,12例在行旋磨术后置入冠脉内支架。 6例患者术中发生较严重的冠脉痉挛 ,经冠脉内给予硝酸甘油后缓解 ;9处 (10 .47% )病变出现了B型以上的内膜撕裂 ,出现无血流或缓慢血流现象发生率为 3.8%。 1例患者术后发生急性Q波心肌梗塞 ,无急诊冠脉搭桥及死亡病例。结论 :冠状动脉旋磨术可选择性用于复杂冠状动脉病变 ,尤其是严重钙化病变 。

Objectives:This study sought to determine the success and complication rates of rotational atherectomy in the treatment of complex coronary artery lesions.Methods:Eighty\|six lesions in 79 patients were treated with rotational atherectomy followed by adjunctive balloon angioplasty or intracoronary stenting.Results:Procedural success was achieved in 96.2% of cases and mean diameter stenosis was decreased from 87.4%±8 78% to 14 6%±10 89%.Angiographic complications included severe coronary vasospasm in 7 6%,dissection of intima(≥type B)in 10 47% and slow flow/no reflow in 3.8% of lesions.One had acute myocardial infarction after procedure,no emergence bypass graft surgery needed,no death.Conclusion:Rotational atherectomy can be performed in selected complex coronary lesions with higher success and lower complication rate. [