低转速和高转速旋磨治疗冠状动脉钙化病变的对比研究

Low and high speed rotational atherectomy in treating calcified coronary lesions(SPEED Ⅰ trial)

目的比较冠状动脉旋磨术中使用低转速和高转速旋磨的安全性和有效性,探讨冠状动脉旋磨术应用不同旋磨速度的临床结果。方法采用单中心前瞻性随机对照研究方法,将2012年9月1日至2017年9月1日因严重冠状动脉钙化行冠状动脉旋磨术的患者随机分成低转速组(140 000 r/min)和高转速组(180 000 r/min),比较手术结果和围术期及30 d内的主要并发症。结果冠状动脉旋磨术86例中共入选患者50例,高转速组25例,低转速组25例。两组冠状动脉旋磨术手术成功率为100.0%比96.0%(P=1.000),其中低转速组1例患者旋磨后仍有球囊扩张不良,放弃置入支架。两组均未发生严重并发症,高转速组4例发生分支急性闭塞(16.0%比4.0%,P=0.346),其中3例有夹层(12.0%比4.0%,P=0.602);2例慢血流或无复流(8.0%比0.0,P=0.470),与低转速组比较差异均无统计学意义。低转速组中1例出现失速、磨头嵌顿。结论冠状动脉旋磨术中选择140 000 r/min和180 000 r/min的转速均可取得较高的手术成功率,高转速可能会增加慢血流或无复流和夹层尤其是分支急性闭塞的发生率,在严重迂曲钙化病变中选择低转速时要预防旋磨头卡住和旋磨效果不良的情况。

Objective To compare the safety and effectiveness in the use of low speed versus high speed rotation in rotational atherectomy（RA）, and to analyse the clinical outcome of RA in different rotational speed. Methods This was a single center prospective randomized study. Patients with calcified coronary lesions were enrolled and randomly assigned to low-speed（140,000 r/min） or high-speed（180,000 r/min） RA from September 1, 2012 to September 1, 2017.The clinical results and main complications were compared in the perioperative period and within 30 days. Results A total of 86 patients had received RA and 50 patients were enrolled with 25 cases in the high speed group and 25 cases in the low speed group.Both groups of RA have achieved high success rate（100.0% vs. 96.0%, P=1.000）.In the low speed group, 1 cases failed balloon dilatation after RA, and further stent implantation had to be given up; No serious complications happened in both group.There were 4 cases with acute occlusion of side branches in the high speed group（16.0% vs. 4.0%, P=0.346）, including 3 cases of dissection（12.0% vs. 4.0%, P=0.602） and 2 cases of slow fl ow（8.0% vs. 0.0, P=0.470）.1 case in the low speed group had speed loss and burr lodged. Conclusions RA can achieve high success rate both in 140,000 r/min and 180,000 r/min.High speed RA may increase the incidence of slow fl ow and dissection especially acute side branch occlusion. Caution should be paid when low speed RA is in severe angulated calcifi ed lesions and beware of burr lodging.