冠状动脉旋磨术联合不同球囊预处理在老年重度冠状动脉钙化介入治疗中的效果比较

Efficacy of RA combined different balloon in interventional treatment of severe coronary artery calcification in the elderly

目的 探讨冠状动脉旋磨术联合普通球囊和切割球囊预扩张在重度冠状动脉钙化介入治疗中的效果和安全性。方法 选取2018年1月~2020年12月宜宾市第二人民医院和宜宾市第三人民医院行介入治疗的重度冠状动脉钙化患者88例,采用随机数字法分为治疗1组44例(旋磨+普通球囊)和治疗2组44例(旋磨+切割球囊)。分别采用冠状动脉旋磨联合普通球囊和切割球囊进行预扩张,观察手术即刻成功率、并发症发生情况、血管内超声相关指标及术后12个月主要心脏不良事件发生率等。结果 治疗1组即刻成功率明显低于治疗2组,差异有统计学意义(81.8%vs 97.7%,P<0.05)。治疗2组术后最小管腔直径、最小管腔面积、获得管腔直径和获得管腔面积明显优于治疗1组[(1.35±0.12)mm vs(1.28±0.09)mm;(5.87±0.37)mm^(2)vs(5.18±0.39)mm^(2);(0.40±0.04)mm vs(0.35±0.03)mm;(3.03±0.20)mm^(2)vs(2.41±0.21)mm^(2),P<0.01]。结论 冠状动脉旋磨+切割球囊预扩张能提高手术即刻成功率,获得更好的血管直径和横切面积,有利于支架置入、更好贴壁和展开。

Objective To explore the efficacy and safety of rotational atherectomy(RA) combined with semicompliant balloon(SB) and cutting balloon(CB) pre-expansion in the interventional treatment of severe coronary artery calcification.Methods A total of 88 patients with severe coronary artery calcification who underwent interventional therapy in the Yibin Second and Third People’s Hospitals from January 2018 to December 2020 were prospectively recruited in this study.They were randomly divided into RA+SB group(44 cases) and RA+CB group(44 cases).The patients in the 2 groups were pretreated with RA combined with SB and CB,respectively.The immediate success rate, incidence of complications, intravascular ultrasound related indicators and incidence of major adverse cardiac events in 12 months after operation were observed.Results The immediate success rate was significantly lower in the RA+SB group than the RA+CB group(81.8% vs 97.7%,P<0.05).The RA+CB therapy achieved better postoperative minimum lumen diameter, minimum lumen area, obtained lumen diameter and obtained lumen area than the RA+SB treatment(1.35±0.12 mm vs 1.28±0.09 mm, 5.87±0.37 mm^(2) vs 5.18±0.39 mm^(2),0.40±0.04 mm vs 0.35±0.03 mm, 3.03±0.20 mm^(2) vs 2.41±0.21 mm^(2),P<0.01).ConclusionRA combined with CB pre-expansion improves immediate success rate of treatment, obtains better vessel diameter and cross-sectional area, and is instrumental in stent implantation, better attachment and deployment.