后退式旋切导管对冠状动脉支架内再狭窄的治疗

Pullback atherectomy for the treatment of in-stent restenosis: Clinical experience and follow-up angiography

目的 :评价后退式旋切导管 (PAC)治疗冠状动脉支架内再狭窄病变的有效性和安全性以及其即刻和近期定量冠状动脉造影结果。方法 :17例支架内再狭窄病变采用PAC治疗 ,应用定量冠状动脉造影评价即刻和近期疗效 ,并与同期的 38例首次介入治疗病变进行比较。结果 :支架内再狭窄组与首次介入治疗组相比PAC器械成功率分别为 10 0 %∶92 %、即刻造影残余狭窄率为 (36± 10 ) %∶(35± 15 ) %、斑块组织获取率为 94 %∶94 % ,两组差异无显著性意义 (P >0 .0 5 )。PAC所产生的血管腔直径增益为 (0 .78± 0 .6 6 )mm ,略低于首次介入治疗者〔(0 .97± 0 .5 5 )mm〕。PAC造成的主要并发症包括原置入支架带出 2例 ,血管内膜撕裂 3例。 6个月随访造影血管腔直径丢失指数为 0 .4 6± 0 .4 5 ,略低于首次介入治疗组 (0 .5 7± 1.13)。造影再狭窄率为 2 9% ,与首次介入治疗组相近 (2 6 % )。结论 :PAC能有效地用于冠状动脉支架内再狭窄病变的处理 ,具有较理想的即刻和近期有效率。

Objective:To evaluate the preliminary clinical experience and early angiographic outcome of pullback atherectomy device in the treatment of in stent restenosis.Methods:Seventeen patients with in stent restenosis lesion were treated with pullback atherectomy device, 38 De novo lesion were compared. Quantitative coronary angiography data was obtained before and after the intervention, and follow up angiography at 6 months.Results:The device success rate were 100% for in stent restenosis lesion and 92% for De novo lesion . The minimal luminal diameter (MLD) gain were ( 0.78 ± 0.66 ) mm for in stent restenosis lesion and ( 0.97 ± 0.55 ) mm for denovo lesion. Angiographic complications after atherectomy for in stent restenosis lesion included vascular dissection in 3 patients and primary stent taken out in 2 patients. The mean lumen loss was ( 0.46 ± 0.45 ) mm, with a binary angiographic restenosis rate of 29% in follow up angiography at 6 manths for the in stent restenosis lesion.Conclusion:Pullback atherectomy seems to be an effective and safety means of plaque removal for coronary in stent restenosis lesion.