血管内超声指导旋磨联合切割球囊治疗重度冠状动脉钙化的临床效果

Clinical effects of intravascular ultrasound-guided rotational atherectomy combined with cutting balloon in the treatment of severe coronary calcification

目的通过临床对比分析,探讨血管内超声(IVUS)指导旋磨联合切割球囊治疗重度冠状动脉钙化的效果。方法选取2013年1月至2022年8月在河南省人民医院心脏中心、郑州大学阜外华中心血管病医院行IVUS检查及冠状动脉造影确诊至少1处病变为重度钙化,且已在IVUS指导下进行经皮冠脉介入术治疗的患者180例为研究对象,其中包括旋磨组78例和旋切组102例,评价支架置入后即刻及术后1年的效果。结果旋磨组与旋切组患者最大钙化弧度分别为(220.66±20.73)°、(225.37±20.64)°,钙化长度比为0.74±0.04、0.73±0.05,支架置入前最小管腔面积为(2.48±0.07)mm^(2)、(2.50±0.09)mm^(2),两组比较差异均无统计学意义(P>0.05)。支架置入后,旋磨组和旋切组患者的最小支架面积分别为(5.40±0.23)mm^(2)和(5.51±0.20)mm^(2),即刻管腔获得面积分别为(2.89±0.32)mm^(2)和(3.02±0.40)mm^(2),两组比较差异均有统计学意义(P<0.05)。术后1年,旋磨组和旋切组患者的最小支架面积分别为(4.65±0.19)mm^(2)和(4.76±0.20)mm^(2),两组患者血管丢失及靶血管重建比较,差异有统计学意义(P<0.05)。结论旋磨联合切割球囊治疗冠状动脉重度钙化病变,可以获得更好的支架置入后效果。降低术后1年靶血管血运重建的比例,改善患者预后。

Objective Through clinical comparative analysis,to explore the effects of intravascular ultrasound-guided rotational atherectomy combined with cutting balloon in the treatment of severe coronary calcification.Method From January 2013 to August 2022,180 patients with at least one lesion diagnosed as severe calcification by IVUS and coronary angiography in the Heart Center of Henan Provincial People‘s Hospital and Fuwai Central Cardiovascular Hospital were selected,including 78 patients in rotational atherectomy group and 102 patients in the rotational atherectomy combined with cutting group.The effects of immediate and 1 year after stent implantation was evaluated.Result The maximum calcification radian of the patients in the rotational atherectomy group and the rotational atherectomy combined with cutting group were(220.66±20.73)°and(225.37±20.64)°,respectively.The calcification length ratio was 0.74±0.04 and 0.73±0.05.The minimum lumen area before stent implantation was(2.48±0.07)mm^(2) and(2.50±0.09)mm^(2).There was no significant difference between the two groups(P>0.05).After stent implantation,the minimum stent area was(5.40±0.23)mm^(2) and(5.51±0.20)mm^(2),and the immediate lumen area was(2.89±0.32)mm^(2) and(3.02±0.40)mm^(2) in the rotational atherectomy group and the rotational atherectomy combined with cutting group,respectively.The difference between the two groups was statistically significant(P<0.05).One year after operation,the minimum stent area of the patients in the rotational atherectomy group and the rotational atherectomy combined with cutting group was(4.65±0.19)mm^(2) and(4.76±0.20)mm^(2),respectively.There were significant differences in vascular loss and target vessel reconstruction(TVR)between the two groups(P<0.05).Conclusion Rotational atherectomy combined with cutting balloon angioplasty in the treatment of severe calcified lesions of coronary artery can achieve better results after stent implantation.Reduce the proportion of target vessel revascularization 1 year after surgery and improve the prognosis of patients.