冠状动脉旋磨术联合药物洗脱支架置入术治疗冠状动脉严重钙化病变的临床研究

Clinical study of rotational atherectomy combined with drug-eluting stent implantation in the treatment of severe coronary artery calcification lesions

目的探讨冠状动脉旋磨术联合药物洗脱支架置入术治疗冠状动脉严重钙化病变的安全性和有效性。方法回顾性分析2010年1月1日至2014年12月31日在北京大学人民医院因冠心病行冠状动脉旋磨术和药物洗脱支架置入术的124例患者,共127处病变。对所有患者进行住院期间和出院后随访。分析其手术特点、并发症及主要不良心血管事件(包括心原性死亡、非致死性心肌梗死、介入治疗相关心肌梗死、靶血管再次血运重建)的发生率。结果 124例患者中95例(76.6%)行直接冠状动脉旋磨术,29例(23.4%)行补救性冠状动脉旋磨术,术后均置入药物洗脱支架。手术即刻成功率为100%,使用的旋磨头直径与血管直径比值为(0.50±0.06),每例患者使用的旋磨头数量为1(1,2)个。行血管内超声检查的36例患者使用的旋磨头直径与血管直径比值为(0.52±0.04),每例患者使用的旋磨头数量为1(1,2)个。术中共有19例(15.3%)患者发生并发症,除1例术后12 h因心原性休克死亡外,其余患者处理后均获得良好效果。术后随访15.8(1.7,60.0)个月,主要不良心血管事件的发生率为4.9%(6/122)。结论对冠状动脉严重钙化的患者宜选用冠状动脉旋磨术联合药物洗脱支架置入术治疗,手术即刻成功率高,并发症少。

Objective To investigate the safety and efficacy of rotational atherectomy followed by drug-eluting stent implantation for treatment of severe calcified coronary lesions. Methods We analysed 124 cases with 127 severe calcified coronary lesions which were treated with rotational atherectomy followed by drug-eluting stent implantation in Peking University Peopleg Hospital from January 1,2010 to September 31, 2014. All patients were followed up in hospital and after discharge. Lesions characteristic, complications and major adverse cardiovascular events （cardiac death, non-fatal myocardial infarction, pereutaneous coronary intervention related myocardial infarction, target vessel revascularization, recurrent angina, intra-stent restenosis and stent thrombosis） were analyzed. Results Direct rotational atherectomy was performed in 76. 6% （95/124） cases, and rescued rotational atherectomy in 23.4% （29/124） cases. Drug-eluting stents implantation were applied to all cases after rotational atherectomy. The immediate procedural success rate was 100%. The average burr/artery ratio was （0. 50 ±0. 06） . The average number of burr used per case was 1 （ 1, 2） . The average burr/artery ratio was （0. 52 ± 0. 04） and the average number of burr used per cases was 1 （ 1, 2） in 36 cases guided with intravascular ultrasound. 19 cases （15.3%） developed complications. One of them died of cardiogenic shock, while others were treated accordingly during procedure with satisfactory results. The incidence of major adverse cardiovascular events was 4.9% during 15.8 （1.7, 60. 0） months follow-up. Conclusions For severe calcified coronary artery lesions rotational atherectomy combined with drug eluting stent implantation is recommended, with highimmediate procedure success rates and less complications.