应用小直径旋磨头联合药物洗脱支架治疗冠状动脉重度钙化病变的疗效  

Rotational atherectomy using small burr combined with drug-eluting stent implantation for the treatment of heavily calcified coronary lesions: analysis of clinical outcomes

作　　者：吴志勇[1] 关瑞锦[1] 陈诗泉[1] 蒋辉[1] 林锋[1] 郭延松[1] 陈斌[1] 卢荔红[1] 陈海峰[1] 陈威[1] 陈明光[1] 

机构地区：[1]福州福建医科大学省立临床医学院福建省立医院心内科,350000

出　　处：《介入放射学杂志》2014年第3期198-202,共5页Journal of Interventional Radiology

摘　　要：目的探讨应用小直径旋磨头行冠状动脉(冠脉)斑块旋磨术联合药物洗脱支架植入术治疗冠脉重度钙化病变的安全性和有效性。方法 2009年1月—2013年4月收治12例冠脉重度钙化病变患者,行冠脉斑块旋磨术联合药物洗脱支架植入术。分析冠脉斑块旋磨特征、血管造影成功率、手术成功率、并发症及随访术后主要心血管事件(包括死亡、心肌梗死、靶病变血运重建)的发生率。结果 12例患者16处病变均成功行冠脉斑块旋磨术并植入药物洗脱支架,均为C型严重钙化病变,旋磨术后冠脉狭窄程度由术前的82.7%±7.6%降到术后的35.2%±10.3%,差异有统计学意义(P<0.05),植入22枚药物洗脱支架。血管造影成功率为100%(16/16)。使用的旋磨头直径与血管直径比值为0.50±0.02,其中93.8%(15/16)病变旋磨头直径≤1.50 mm。手术成功率为91.7%(11/12)。术中1例(8.3%)出现慢血流、围手术期心肌梗死。术中未发生急性血管闭塞、冠脉穿孔、夹层、死亡及急诊冠脉旁路移植术病例。所有患者随访(7.1±2.5)个月,无再发心绞痛,未见主要心血管事件发生。结论应用小直径旋磨头行冠脉斑块旋磨术联合药物洗脱支架植入术治疗冠脉严重钙化病变安全、有效,近期疗效满意。Objective To investigate the safety and efficacy of rotational atherectomy with small burr together with subsequent drug- eluting stent implantation in treating patients with heavily calcified coronary lesions. Methods During the period from January 2009 to April 2013 a total of 12 patients with heavily calcified coronary lesions were admitted to authors＇ hospital. The diagnosis was confirmed by angiography in all patients. Rotational atherectomy with small burr combined with subsequent drug-eluting stent implantation were carried out. The clinical data, including angiography success rate, procedure success rate, complications and postoperative main adverse cardiovascular events such as death, myocardial infarction and target lesion revascularization, etc. were retrospectively analyzed. Results A total of sixteen heavily calcified lesions of Type C in 12 patients were successfully treated with rotational atherectomy and drug-eluting stent placement. After rotational atherectomy the stenosis degree of the coronary artery decreased from preoperative （82.7 ± 7.6）% to postoperative （35.2 ± 10.3）%, the difference between the two was statistically significant （P 〈 0.05）, and a total of 22 drug-eluting stents were successfully implanted. The angiography success rate was 100%. The average burr-to-artery ratio used in the procedure was （0.50 ± 0.02）, the burr with the diameter ≤ 1.50 mm was employed in treating 93.7% of lesions （15/16）. The success rate of the procedure was 91.7% （11/12）. During the procedure stasis of blood flow was observed in one patient, and the patient developed perioperative myocardial infarction. No acute vascular occlusion, coronary perforation, dissection or death occurred, and no patient needed to receive emergency coronary artery bypass grafting. All the patients were followed up for （7.1 ± 2.5） months, and no recurrence of angina pectoris or major cardiovascular event was observed. Conclusion For the treatment of heavily calcified coronary lesions, rotatio

关 键 词：冠状动脉疾病 钙质沉着症 旋磨术 药物洗脱支架 

分 类 号：R541.4[医药卫生—心血管疾病]