旋磨术联合切割球囊成形术治疗冠状动脉重度钙化病变  

Combined rotational atherectomy and cutting balloon angioplasty for severe calcified coronary lesions

作　　者：汤喆[1] 白静[1] 高磊[1] 田进文[1] 薛桥[1] 刘谟焓[1] 申红远 王禹[1] 苏绍萍[2] 

机构地区：[1]解放军总医院老年心血管病研究所,北京100853 [2]解放军总医院门诊部,北京100853

出　　处：《中华老年心脑血管病杂志》2014年第6期568-570,共3页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

基　　金：解放军总医院苗圃基金(13KMZ02)

摘　　要：目的血管内超声评价旋磨术联合切割球囊成形术治疗冠状动脉重度钙化病变的安全性及有效性。方法收集冠状动脉造影及血管内超声检查确认至少1处病变为高度钙化,并行旋磨术处理的冠心病患者80例,根据是否使用切割球囊分为单纯旋磨组34例和旋磨联合切割组46例。患者在支架置入前及置入后均行血管内超声检查,评价支架置入效果。结果单纯旋磨组与旋磨联合切割组最大钙化弧度分别为(215.88±21.81)°vs(226.55±21.59)°,钙化长度比为(0.72±0.06)vs(0.78±0.05),支架置入前最小管腔面积为(2.52±0.07)mm2 vs(2.46±0.09)mm2,2组比较差异无统计学意义(P>0.05)。支架置入后,旋磨联合切割组最小支架面积(6.12±0.37)mm2和即刻管腔获得面积(3.66±0.34)mm2,单纯旋磨组分别为(5.42±0.24)mm2和(2.90±0.24)mm2,2组比较差异有统计学意义(P=0.016)。2组术中并发症的发生比例比较,差异无统计学意义(P>0.05)。结论在冠状动脉重度钙化病变中,使用旋磨术联合切割球囊成形术可以获得更好的支架置入后效果。Objective To assess the safety and efficiency of rotational atherectomy （RA ） and cutting balloon （CB） angioplasty for severe calcified coronary lesions according to intravascular ultra-sound （IVUS） .Methods Eighty CHD patients with at least one severe calcified coronary lesion detected by coronary angiography ,IVUS and RA were divided into RA group （n=34） and combined RA and CB angioplasty group （n=46） .The patients underwent IVUS before and after stent implantation .The outcome of stent implantation was assessed in the patients .Results The mean calcium arc and the mean calcium length ratio were lower in RA group than in combined RA and CB angioplasty group （215 .88 ± 21 .81° vs 226 .55 ± 21 .59° ,0 .72 ± 0 .06 vs 0 .78 ± 0 .05 ,P〈0.05） .No significant difference was found in the minimum lumen area between the two groups before stent implantation （2 .52 ± 0 .07 mm^2 vs 2 .46 ± 0 .09 mm^2 ,P〉0 .05） .The minimum stent area and acute lumen gain area were significantly larger in ombined RA and CB angioplasty group than in RA group after stent implantationin （6 .12 ± 0 .37 mm^2 vs 5.42 ± 0 .24 mm^2 ,3 .66 ± 0 .34 mm^2 vs 2 .90 ± 0 .24 mm^2 ,P=0 .016） .Conclusion Combined RA and CB angioplasty can achieve better stent implantation outcomes in patients with severe calcified coronary lesions .

关 键 词：冠状动脉疾病 超声检查  介入性 斑块切除术  冠状动脉 

分 类 号：R541.4[医药卫生—心血管疾病]