血管内超声指导下对冠状动脉严重钙化病变行旋磨介入治疗疗效评估Efficiency of rotational atherectomy with drug-eluting stents by intravascular ultrasound for heavily calcified lesions
王昆,徐标,宋杰,王涟,黄为,高玲,张静梅
摘要(Abstract):
目的评估血管内超声(IVUS)指导下冠状动脉旋磨术联合药物洗脱支架(DES)治疗严重钙化病变的疗效。方法 13例冠状动脉严重钙化患者在IVUS指导下行冠状动脉旋磨及支架置入术,评估手术即刻成功率、术后管腔最小直径、最小直径狭窄率、管腔有效面积变化及随访结果。结果 13例中,单支病变1例(7.7%),双支病变3例(23.1%),三支病变6例(46.2%),左主干+三支病变1例(7.7%),左主干病变2例(15.4%)。术前、术后肌钙蛋白T、肌酸激酶同工酶与肌酸酐比较,差异无统计学意义。靶血管管腔最小直径由术前(2.0±0.3)mm增大至术后的(3.6±0.8)mm,直径狭窄率由术前的(74.5±6.8)%减少至术后的(20.3±12.5)%,管腔有效面积由术前的(4.0±1.4)mm2增大至术后的(10.7±5.5)mm2,差异均有统计学意义。即刻手术成功率100%,术后随访期间无心绞痛再发、心肌梗死及靶血管再次血运重建。结论 IVUS指导下冠状动脉旋磨术联合DES可安全用于冠状动脉严重钙化病变患者,提高了介入手术的成功率。
关键词(KeyWords): 冠状动脉;严重钙化;血管内超声;旋磨术;药物洗脱支架
基金项目(Foundation):
作者(Author): 王昆,徐标,宋杰,王涟,黄为,高玲,张静梅
参考文献(References):
- [1]Aldrich RF,Brensike JF,Battaglini JW,et al.Coronary calcifications in the detection of coronary artery disease and comparison with electrocardiographic exercise testing.Results from the National Heart,Lung,and Blood Institute's typeⅡcoronary intervention study.Circulation,1979,59:1113-1124.
- [2]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.
- [3]Di Sciascio G,Patti G,Nasso G,et al.Early and long-term results of stenting of diffuse coronary artery disease.Am J Cardiol,2000,86:1166-1170.
- [4]Walton AS,Pomerantsev EV,Oesterle SN,et a1.Outcome of narrowing related side branches after high-speed rotational atherectomy.Am J Cardiol,1996,77:370-373.
- [5]Cavusoglu E,Kini AS,Marmur JD,et al.Current status of rotational atherectomy.Catheter Cardiovasc Interv,2004,62:485-498.
- [6]Tsubokawa A,Ueda K,Sakamoto H,et al.Acute and long-term outcomes of rotational atherectomy in small(<3.0 mm)coronary arteries.J Interv Cardiol,2003,16:315-322.
- [7]马根山,冯毅,陈忠,等.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.中国介入心脏病学杂志,2007,15:8-10.
- [8]叶慧明,卢明瑜,王伟民,等.冠状动脉旋磨术联合药物洗脱支架治疗冠状动脉严重钙化病变的临床研究.中国循环杂志,2012,27:258-261.
- [9]张建起,王燕,梁国庆,等.血管内超声指导下冠状动脉内旋磨术联合药物洗脱支架治疗严重钙化病变.医疗卫生装备,2011,32:55-58.
- [10]Uetani T,Ishii H,Sakai S,et al.Beneficial effect of rotational atherectomy with low platform speed on late outcomes.Int J Cardiol,2004,94:35-40.