旋磨联合切割球囊治疗冠状动脉重度钙化病变的可行性及安全性

Feasibility and safety of rotational atherectomy combined with cutting balloon angioplasty for severely calcified coronary lesions

目的探讨旋磨联合切割球囊(CB)治疗冠状动脉重度钙化病变的疗效及安全性。方法选取冠状动脉造影及血管内超声(IVUS)检查显示冠状动脉缺血相关血管重度狭窄且内膜重度钙化患者32例,根据治疗方法不同分为对照组(旋磨后选用普通半顺应性球囊进行预扩张,n=18)和CB组(旋磨联合CB治疗,n=14),评估两组患者支架置入后即刻管腔获得及手术安全性。结果两组患者旋磨前在钙化弧度、参考血管直径、最小管腔直径、最小管腔横截面积(CSA)、狭窄程度方面差异无统计学意义(P>0.05)。介入治疗过程中两组患者选择的旋磨头直径、置入支架长度及非顺应性球囊后扩张比率等方面比较,差异均无统计学意义(P>0.05)。支架置入后,CB组最小管腔CSA[(6.04±0.72)mm2]高于对照组[(5.43±0.48)mm2,P<0.05]、即刻管腔面积获得[(4.86±0.63)mm2]也高于对照组[(3.91±0.57)mm2,P<0.05]。术后平均随访13.2个月,对照组仅有1例患者出现支架内再狭窄再次经皮冠状动脉介入治疗(PCI),未发生支架内血栓或急性心肌梗死;CB组1例死于肺癌。结论对冠状动脉重度钙化病变实施旋磨联合CB成形术,即刻管腔获得更加明显,安全性良好。

Objective To assess the feasibility and safety of rotational atherectomy(RA)combined with cutting balloon(CB)angioplasty for severely calcified coronary lesions.Methods 32 patients with severely calcified lesions were apportioned to receive intensive plaque modification with RA and CB(the CB group,n=14)or RA with conventional plain balloon(the control group,n=18),evaluated the immediate endovascular access and surgical safety after stent implantation in both groups.Results The CB group and the control group were similar in baseline mean arcs of superficial calcium,and minimum lumen cross-sectional areas(CSAs).The mean minimum stent CSA after percutaneous coronary intervention(PCI)of the CB group[(6.04±0.72)mm^2]was significantly larger than that of the control group[(5.43±0.48)mm^2,P<0.05].Patients in the CB group achieved significantly larger acute CSA gain after PCI[(4.86±0.63)mm^2]relative to the control group[(3.91±0.57)mm^2,P<0.05].The groups were similar in rates of periprocedural complications.Conclusion Rotational atherectomy combined with cutting balloon angioplasty is safe and effective for patients with severely calcified coronary lesions.