斑块旋磨术联合药物洗脱支架置入术治疗冠状动脉弥漫性严重钙化病变的近期效果分析

Short-term outcome of rotational atherectomy followed by drug-eluting stenting in heavily calcified coronary long lesions

目的探讨斑块旋磨术联合药物洗脱支架置入术治疗冠状动脉弥漫性严重钙化病变的手术安全性和近期效果。方法回顾性分析2011年1月1日至2016年5月31日在北京大学人民医院因冠状动脉严重钙化病变行斑块旋磨术联合药物洗脱支架置入术的109例冠心病患者,共114处病变,其中28例患者在术中行血管内超声检查。按钙化病变的长度分为弥漫性钙化病变组(钙化病变长度≥25 mm,68例、72处病变)和局限性钙化病变组(钙化病变长度<25 mm,41例、42处病变)。分析两组患者病变及手术特点、手术成功率、并发症及住院期间主要不良心血管事件(MACE,包括心源性死亡、非致死性心肌梗死和支架内血栓形成)的发生情况。结果弥漫性钙化病变组钙化病变长度[(38.2±11.0)mm比(15.0±4.9)mm,P<0.001]、旋磨次数[(6.17±1.61)次比(4.02±1.20)次,P<0.001)]、置入支架数[(2.31±0.78)枚比(1.60±0.70)枚,P<0.001]显著大于局限性钙化病变组,差异有统计学意义;与局限性钙化病变组相比,弥漫性钙化病变组手术即刻成功率(98.5%比100%,P=0.453)、并发症发生率(41.2%比34.1%,P=0.673)、住院期间MACE发生率(41.2%比31.7%,P=0.484)相当,差异均无统计学意义。结论注意手术操作的规范性、采取恰当的措施预防和处理术中并发症,可以安全地对冠状动脉弥漫性严重钙化病变进行斑块旋磨术并置入药物洗脱支架,手术即刻成功率及近期效果满意。

Objective To investigate the safety and short-term outcome of rotational atherectomy followed by drug-eluting stenting in heavily calcified coronary long lesions. Methods From Jan 1,2011 to May 31,2016,109 cases with 114 heavily calcified coronary lesions which were treated with rotational atherectomy followed by drug-eluting stenting in Peking University People＇ s Hospital were included. They were divided into diffuse lesion group（ lesion ≥ 25 mm,68 cases,72 lesions） and focal lesion group（ lesion 25 mm,41 cases,42 lesions）. All patients were followed up in hospital. Procedure parameters,procedural complications（ dissection,perforation,slow flow / no flow and procedural related myocardial infarction）,procedural success and major adverse cardiovascular events（ cardiac death,non-fatal myocardial infarction and stent thrombosis） were analyzed. Results The procedural success rate was 98. 5%（ 67 /68）in diffuse lesion group and 100%（ 41 /41） in focal lesion group（ P = 0. 453）. Complication rates did not differ between the two groups（ 41. 2% and 34. 1%,P = 0. 673）. Major adverse cardiovascular events rates were 41. 2% and 31. 7%,P = 0. 484. Conclusions Treating coronary lesions ≥ 25 mm in length with rotational atherectomy followed by drug-eluting stenting does not impact the short-term outcome when treating carefully and correctly. Procedural success rate and in-hospital outcome is satisfactory.