高频旋磨联合药物洗脱支架植入术治疗冠状动脉严重钙化的疗效

目的评价冠状动脉内旋磨术联合药物洗脱支架治疗冠状动脉严重钙化病变的疗效。方法32＂N冠状动脉严重钙化病变患者行冠状动脉内旋磨术联合药物洗脱支架植入术。观察其即刻造影成功率及住院期间不良心血管事件发生率。结果冠状动脉造影结果均为B2、C型严重钙化病变。旋磨头均成功通过病变，所有患者均在旋磨术后植入药物洗脱支架。病变由术前狭窄（89．3±7．8）％减至术后残余狭窄（8．2±1．7）％，术后即刻造影成功率100％。1例（3．1％）术中出现旋磨头断裂；8例（25％）术后出现肌钙蛋白I升高〉3倍正常值上限，符合非Q波心肌梗死；1例（3．1％）术后〈24h死亡，死亡原因考虑为腹膜后血肿导致失血性休克；无冠状动脉痉挛、冠状动脉穿孔、慢血流、无复流、急性再次介入治疗及急诊冠状动脉旁路移植术（CABG）。结论冠状动脉内旋磨术联合药物洗脱支架植入术治疗冠状动脉严重钙化病变并发症少，成功率高，安全可行。

Objective To evaluate the effect of the combination of rotational atherectomy （ RA ） with drug-eluting stent （ DES ） on heavily calcified lesions. Methods 32 patients with severely calcified lesions were treated with RA followed by DES. The immediate success rate and the incidence rate of MACE during hospitalization were analyed. Results All the lesions were either type B2 or C heavily calcified lesions under angiography. The burrs passed through the lesions successfully in all cases. All patients received DES after RA. The diameter stenosis rate of the lesions decreased from （ 89.3 ± 7.8 ） % to （ 8.2± 1.7 ） %, the immediate angiography success rate was 100%. The burr was fractured in coronary artery during procedure in 1 case （ 3.1% ） . 8 patients whose troponin I levels were elevated more than 3 times the normal high limit （ NHL ） , had non-Q wave myocardial infarction. One patient was dead due to hemorrhagic shock resulted from retroperitoneal hematoma. 24 hours after procedure. No coronary vasospasm, perforation, no-reflow, slow reflow occurred. No one needed emergent revascularization and CABG. Conclusion The combination of RA with DES was effective and safe in the treatment of coronary heavily calcified lesions, and may increase the success rate of the procedure.