冠状动脉内旋磨术联合支架术治疗严重钙化病变的疗效及随访研究Efficacy of rotational atherectomy with stents for heavily calcified lesion
马根山,冯毅,陈忠,沈成兴,罗丹,戴启明
摘要(Abstract)：
目的评价冠状动脉(冠脉)内旋磨术联合支架术治疗严重钙化病变的疗效及中期随访结果。方法对21例冠心病患者的严重钙化病变行冠脉内旋磨术及支架术治疗,6例患者在血管内超声的引导下进行,观察其治疗的即刻成功率及6个月的随访结果。结果行冠脉内旋磨术的21例患者,冠脉造影结果均为В2、C型严重钙化病变。旋磨头均成功通过了病变,15例(71.4%)病例仅选择1.25mm的旋磨头,3例(14.3%)病例仅选择1.5mm旋磨头,3例(14.3%)病例使用了2个旋磨头。全部病例均联合应用经皮冠脉血管成形术(PTCA),19例(90.5%)在旋磨术后置入支架。2例(9.5%)在术中发生冠脉痉挛;1例(4.8%)发生无血流现象;无冠脉穿孔、死亡、急性心肌梗死及急诊冠脉旁路移植术(CABG)。对15例患者进行了术后6个月的冠脉造影随访,有2例(13.3%)发生支架内再狭窄。结论冠脉内旋磨术联合支架术治疗严重钙化病变,去除钙化斑块增大管腔,提高了严重钙化病变的经皮冠脉介入治疗(PCI)成功率。
关键词(KeyWords)： 冠状动脉硬化;支架;预后;血管成形术,经腔,经皮冠状动脉
基金项目(Foundation):
作者(Author): 马根山,冯毅,陈忠,沈成兴,罗丹,戴启明
参考文献(References)：
- [1]Ellis S,Popma J.Relation of clinical presentation,stenosismorphology,and operator technique to the procedural results of rotational atherectomy-facilitated angioplasty.Circulation,1994,89:882-892.
- [2]Cavusoglu E,Kini AS,Marmur JD,et al.Current status of rotational atherectomy.Catheter Cardiovasc Interv,2004,62:485-498.
- [3]Antony SW,Eugene VP,Stephen NO,et al.Outcome of narrowing related side branches after high-speed rotational atherectomy.Am J Cardiol,1996,77:370-373.
- [4]Tsubokawa A,Ueda K,Sakamoto H,et al.Acute and long-term outcomes of rotational atherectomy in small(<3.0mm)coronary arteries.J Interv Cardiol,2003,16:315-322
- [5]杨希立,肖长华.冠状动脉旋磨术及经皮冠状动脉成形术在复杂病变介入治疗中的应用.中国心血管杂志,2002,7:259-261.
- [6]Mintz GS,Pichard AD,Popma JJ,et al.Determinants and correlates of target lesion calcium in coronary artery disease:A clinical angiographic and intravascular ultrasound study.JACC,1997,29:268-274.
- [7]Kobayashi Y,Teirstein P,Linnemeier T.Rotational atherectomy(stentablation)in a lesion with stent underexpansion due to heavily calcified plaque.Catheter Cardiovasc Interv,2001,52:208-211.
- [8]Maclsaac AI,Baas TA,Buchbinder M,et al.High speed rotational atherectomy:outcome in calcified and non-calcified coronary artery lesions.JACC,1995,26:731-736.
- [9]Reimers B,Stankovic G,Prati F,et al.Directional atherectomy of a calcified lesion using a new atherectomy device.Catheter Cardiovasc Interv,2002,56:222-226.
- [10]Rainer H,Gary SM,Kenneth MK,et al.Comparative early and nine-monh results of rotational atherectomy,stents,and the combination of both for calcified lesions in large coronary arteries.Am J Cardiol,1998,81:552-557.
- [11]Patric LW,Theodore AB,Robert MK,et al.Results of the study to determine rotablator and transluminal angioplasty strategy(STRATAS).Am J Cardiol,2001,87:699-705.
- [12]Barry MK,Robert DS,Mojares JJ,et al.Optimal burr and adjunctive balloon sizing reduces the need for target artery revascularization after coronary mechanical rotational atherectomy.Am J Cardiol,1996,78:1224-1229.
- [13]Tadayuki U,Hideki Ishii,Shin-ichi S,et al.Beneficial effect of rotational atherectomy with low platform speed on late outcomes.Int J Cardiol,2004,94:35-40.