张慧平,赵迎,李辉,唐国栋,艾虎,郑耐心,孙福成

• 1:国家老年医学中心北京医院心脏中心

摘要(Abstract)：

目的分析冠状动脉旋磨术围术期并发症的发生和处置。方法连续入选2012年1月至2016年12月在北京医院心脏中心接受冠状动脉旋磨术的107例冠心病患者,总结冠状动脉旋磨术围术期并发症的发生率和处置情况。结果 (1)冠状动脉内旋磨患者术后的血清肌酸激酶同工酶(CK-MB)[4.1(2.4~14.1)U/L比1.5(1.0~2.1)U/L,P<0.001]和心肌肌钙蛋白Ⅰ(cTnⅠ)[0.28(0.11~1.11)ng/ml比0.01(0.01~0.02)ng/ml,P<0.001]水平较旋磨术前均有显著升高。(2)旋磨术的靶病变有104例(97.2%)为复杂病变(B2/C型病变)。(3)共21例(19.6%)患者发生了旋磨术围术期并发症,旋磨后出现冠状动脉慢血流5例(4.7%),冠状动脉痉挛1例(0.9%),冠状动脉夹层9例(8.4%),有6例(5.6%)患者出现了一过性严重心动过缓(其中仅1例植入临时起搏器),有2例(1.9%)患者发生了旋磨头嵌顿。有1例(0.9%)患者发生边支闭塞;2例(1.9%)患者发生血管并发症(1例股动脉穿刺处血肿、1例纵隔血肿),术后出现对比剂肾病1例(0.9%)。所有旋磨患者围术期并发症均被安全处置,所有接受旋磨术的患者即刻手术成功率为98.1%,无住院期间急性或亚急性支架内血栓形成、心源性死亡、紧急冠状动脉旁路移植术(CABG)等事件发生。结论冠状动脉旋磨术的并发症并不少见,但严重并发症少,总体安全性良好,即刻手术成功率高。

关键词(KeyWords)： 经皮冠状动脉介入治疗;冠状动脉内斑块旋磨术;并发症

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 张慧平,赵迎,李辉,唐国栋,艾虎,郑耐心,孙福成

参考文献(References)：

• [1]Cavusoglu E,Kini AS,Marmur JD,et al.Current status of rotational atherectomy.Catheter Cardiovasc Interv,2004,62(4):485-498.
• [2]Zimarino M,Corcos T,Bramucci E,et al.Rotational atherectomy:a“survivor”in the drug-eluting stent era.Cardiovasc Revasc Med,2012,13(3):185-192.
• [3]刘健,席晓霞,王伟民,等.冠状动脉旋磨术联合药物洗脱支架置人术治疗冠状动脉严重钙化病变的临床研究.中国介入心脏病学杂志,2015,23(10):550-554.
• [4]Warth DC,Leon MB,O’Neill W,et al.Rotational atherectomy multicenter registry:acute results,complications,6-month angiographic follow-up in 709 patients.J Am Coll Cardiol,1994,24(3):641-648.
• [5]Rainer H,Gary SM,Kenneth MK,et al.Comparative early and nine-month results of rotational atherectomy,stents,and the combination of both for calcifi ed lesions in large coronary arteries.Am J Cardiol,1998,81(5):552-557.
• [6]罗建方,董豪坚,李光,等.冠状动脉斑块旋磨术并发症分析.中华心血管病杂志,2013,41(6):470-473.
• [7]Aldrich RF,Brensike JF,Battaglini JW,et al.Coronary calicif ication in the detection of coronary disease and comparison with elec-tocardiographic exercise testing:Results from the National Heart,Lung,and Blood Institue’s type II coronary intervention study.Circulation,1979,59(6):1113-1124.
• [8]Tsubokawa A,Ueda K,Sakamoto H,et al.Acute and longterm outcomes of rotational atherectomy in small(<3.0mm)coronary arteries.J Interv Cardiol,2003,16(4):315-322.
• [9]Abdel-Wahab M,Richardt G,Joachim Buttner H,et al.High speed rotational atherectomy before paclitaxel-eluting stent implantation in complex calcified coronary lesions:the randomized ROTAXUS(Rotational Atherectomy Prior to Taxus Stent Treatment for Complex Native Coronary Artery Disease)tlial.JACC Cardiovase Interv,2013,6(1):10-19.
• [10]Abdel-Wahab M,Baev R,Dicker P,et al.Long-term clinical outcome of rotational atherectomy followed by drug-eluting stent implantation in complex calcifi ed coronary lesions.Catheter Cardiovasc Interv,2013,81(2):285-291.
• [11]中华医学会心血管病学分会介入心脏病学组.2016中国经皮冠状动脉介入治疗指南.中华心血管病杂志,2016,44(5):382-400.
• [12]葛均波,王伟民,霍勇.冠状动脉内旋磨术中国专家共识.中国介入心脏病学杂志,2017,25(2):61-66.
• [13]Grise MA,Yeager MJ,Teirstein PS.A case of an entrapped rotational atherectomy burr.Catheter Cardiovase Interv,2002,57(1):31-33.
• [14]Kimura M,Shiraishi J,Kohno Y.Successful retrieval of an entrapped Rotablator burr using 5 Fr guiding catheter.Catheter Cardiovasc Interv,2011,78(4):558-564.