血管内超声指导旋磨预处理冠状动脉钙化病变临床观察

Clinical observation on the pretreatment of coronary calcification lesions by rotational atherectomy under intravascular ultrasound guidance

目的探讨血管内超声(intravascular ultrasound,IVUS)指导旋磨预处理冠状动脉钙化病变临床疗效及并发症。方法回顾性分析25例经旋磨术联合药物洗脱支架处理的冠脉钙化病变患者,分析IVUS检查结果及并发症发生情况,分别比较旋磨及切割球囊(cutting balloon,CB)使用前后最小管腔直径、最小管腔面积、最狭窄处狭窄程度及最大钙化弧度的变化。结果 27例靶血管中21例使用了IVUS指导(77.78%),包括IVUS+CB 11例(40.74%)、IVUS+非顺应性球囊(non complaint balloon,NCB)10例(37.04%)。旋磨处理前后血管最小管腔直径、最小管腔面积、斑块负荷及钙化弧度变化无显著差异,斑块表面的钙化结节减轻,钙化环上可见到裂隙或者部分钙化环厚度较前变薄;11例旋磨后进行了CB处理,处理后最小管腔直径、最小管腔面积、斑块负荷较旋磨后明显改善(P=0.000,P=0.043,P=0.030),钙化弧度无明显变化,能见到钙化环裂隙更明显、部分病变上能见到切割痕迹。1例术中发生旋磨头嵌顿并发血管破裂,1例发生亚急性支架内血栓。结论旋磨术对钙化斑块、钙化结节有较好的修饰作用,对于管腔的直径及管腔面积的影响较小,联合使用CB可有效增加预处理效果,术中IVUS有较大指导价值。

Objective To explore the clinical effect and complications of coronary calcification lesions by rotational atherectomy under intravascular ultrasound(IVUS)guidance.Methods 25 patients with coronary calci⁃fication lesions treated by rotational atherectomy and drug⁃eluting stent were analyzed retrospectively.The results of IVUS and complications were analyzed.The minimum lumen diameter,the minimum lumen area,the plaque burden and the maximum calcification arc were compared before and after the use of rotational atherectomy and cutting balloon(CB).Results Among 27 target vessels,21 cases used IVUS guidance(77.78%),including 11 cases of IVUS+CB(40.74%),10 cases of IVUS+Non complaint balloon(NCB)(37.04%).There was no significant difference in the minimum lumen diameter,the minimum lumen area,and plaque burden and calcification arc by rotational atherectomy.The calcified nodule was lightened.Fracture can be seen on some calcification ring.Some calcified rings were thinner than before rotational atherectomy.11 cases were treated with CB after rotational ather⁃ectomy.The minimum lumen diameter,the minimum lumen area and the plaque burden were significantly improved(P=0.000,P=0.043,P=0.030),but the calcification arc had no significant change.The cracks of calcified ring are more obvious,and the cutmarks can be seen on some lesions.In one case,the vessel ruptured due to stuck of burr head.One patient occurred subacute stent thrombosis.Conclusions The effect of rotational atherectomy on calcified nodule was better than that on the diameter and area of lumen.Combined use of CB can effectively increase the pretreatment effect.IVUS has great guiding value in operation。